Abstracts

Rationale: Approximately 30% of patients with epilepsy have refractory epilepsy, that is, have a failure of adequate trials of two tolerated, appropriately chosen, and used antiepileptic drug schedules to achieve sustained relief of seizures. Some of these patients are not surgery candidates, so it is necessary to search for alternative treatments for epilepsy such as palliative surgery, neuromodulation, and a ketogenic diet (KD).Recent studies have found a significantly positive outcome with the use of the KD for treatment of refractory epilepsy in children and adults.Ketocal is a nutritionally complete powdered formula, containing a 4: 1 ratio (fats: carbohydrates + proteins) capable of reaching and maintaining a state of ketosis in patients with refractory epilepsy or resistant to drug treatment. Ketocal is the first 4: 1 ketogenic formula in Mexico. Methods: We present two cases of patients treated with Ketocal when determining epilepsy refractory to pharmacological treatment:Case 1: Male patient of 3 years of age with a history of hypoxic-ischemic encephalopathy at birth with the presence of epileptic seizures from 6 months of age, later with evidence of multiple cortical dysplasias in MRI, repetitive epileptic states, last hospitalization with epileptic superrefractory to treatment with thiopental, magnesium valproate, brivaracetam, lacosamide, and clobazam. It was decided to start an enteral ketogenic diet with Ketocal use with fast induction of ketosis with a response in 5 days, resolution of epileptic status, and 70% reduction of seizure after the start of the diet until the moment without adverse events.Case 2: A 4-year-old female patient with a diagnosis of lennox gastaut, predominantly atonic epileptic seizures with a long-term use of several antiepileptic drugs with partial response, without evidence of structural alterations in MRI at the moment with topiramate, levetiracetam, valproate, and clobazam.Ketocal treatment was decided upon in addition to a artisan ketogotic diet with adequate response to the treatment determined in 80% reduction of crisis in addition to recovery of cognitive skills with improvement in tasks of language and comprehension. Results: The response of both patients to the ketogenic diet was satisfactory, until now the same treatment is continued in ketosis surveillance as well as the registry of crisis number, lipid profile, and liver enzymes as well as electroencephalogram, during the use of the diet was decided to reduce topiramate to the risk of nephrocalcinosis without evidence of adverse effects related to diet. Conclusions: The use of ketogenic diet has been well described for many years, however in Mexico the protocols for the administration of the diet are not well designed.The need for a multidisciplinary team of specialists is necessary as well as the monitoring of adverse effects related to diet in addition to the adjustment of antiepileptic drugs in each patient.The advantages of using Ketocal in these cases have been the absence of hypoglycemia, increased blood lipids in addition to not requiring nutrients such as calcium or magnesium in the treated patients. Funding: No funding