Abstracts

Rationale: Ketogenic diet (KD) has been increasingly used in intractable epilepsy, but the underlying mechanisms remain elusive. Data on its effectiveness in traumatic brain injury (TBI) and TBI associated epilepsy is limited to animal experiments (1,2) and in status epilepticus (3). There is need to evaluate effectiveness of KD in TBI associated epilepsy

Methods: We present two cases of Non-accidental trauma (NAT), who subsequently developed drug resistant epilepsy.

Case 1: 3-year ambidextrous female, born at 33.4 weeks’ gestation had sustained non-accidental trauma injury at 4 months of age. CT head demonstrated bilateral subdural hemorrhage while MRI brain findings suggestive of post traumatic encephalomalacia in left cerebral hemisphere and right frontal lobe, which evolved into volume loss and left temporal lobe injury involving hippocampus. She manifested with secondarily generalized tonic-clonic seizures requiring phenobarbital, levetiracetam and lacosamide for seizure control. At the age of 8 months, she developed asymmetric infantile spasms, which failed high dose oral prednisolone 8-week regimen starting at 8 mg/kg/day dose. Infantile spasms showed dramatic response with cessation of clinical spasms within 96 hours of starting KD, while hypsarrhythmia resolution was demonstrated at 12 weeks of initiation of ketogenic diet therapy. She showed marked developmental progress and was successfully weaned off all anti-epileptic drugs (AEDs) within 12 months of initiation of KD. She has been successfully weaned off KD and remained seizure free for the past 8 months.

Case 2: 5-year male, born at 36 weeks' gestation age had sustained non-accidental trauma at 4 months of age. Patient head CT showed extensive left extracranial parietotemporal hemorrhage and follow up MRI brain demonstrated laminar necrosis involving left cerebral hemisphere, which evolved into left porencephaly. Patient developed symptomatic localization related epilepsy controlled with levetiracetam, lacosamide, topiramate and clonazepam. Later at 23 months of age, he developed asymmetric infantile spasms, which showed greater than 50% seizure reduction with Clobazam treatment. After 8 weeks of clobazam treatment, patient continued having occasional spasms, which were completely controlled within two weeks of initiation of Ketogenic diet therapy. Patient has remained seizure free for almost three years, currently on KD and Rufinamide

Results: Ketogenic diet therapy successfully controlled refractory Infantile spasms in two patients affect with traumatic brain injury. Long term Ketogenic diet therapy showed resolution of neuronal excitability and promotes development.

Conclusions: We conclude that there is a need to explore role of KD as an antiepileptic therapy in TBI associated refractory epilepsy.

Funding: Please list any funding that was received in support of this abstract.: None.