Abstracts

Rationale: The ketogenic diet (KD) is an effective treatment for medically refractory epilepsy requiring strict compliance and time-consuming food preparation, which can limit its adherence and success. We evaluated the change in quality of life (QOL) among children with refractory epilepsy treated with the classic KD. Methods: Children with epilepsy who initiated the KD between January 2013 and December 2015 were identified at hospital admission. Pertinent clinical information, including seizure frequency, was abstracted from medical records retrospectively. Parents or care providers completed the Impact of Pediatric Epilepsy Scale (IPES) and the Hague Restrictions in Childhood Epilepsy Scale (HARCES) at the time of KD initiation and again after 3 months. Results: Fourteen children (male=4, 29%) with a median age of 4.1 years (IQR 1.4-7.5) were included. The majority of children had baseline developmental impairment (n=8, 57%, 2 mild delay, 6 moderate-severe delay). Four patients, all with moderate-severe delay, received formula-only KD (2 oral, 2 enteral). At 3 months, 4 patients (29%) were seizure-free, 8 patients (57%) achieved 50% seizure reduction, and 2 patients (14%) had no seizure improvement. The median IPES score was 10 (IQR 5-17) at initiation vs. 14 (IQR 5-19) at 3 months (p=0.73). The median HARCES score was 26 at initiation (IQR 17-30) vs.28 (IQR 23-35) at 3 months (p=0.12). Among children receiving formula-only, the HARCES score worsened (initiation=22 vs. 3 months=35, p=0.02) but not the IPES score (initiation=15 vs. 3 months=15, p=0.77) at 3 months. Improvements to both IPES and HARCES scores were observed in only two seizure-free patients. Conclusions: Most children with refractory epilepsy experienced seizure frequency reduction or resolution after 3 months on the KD. The QOL measures did not change after initiating the diet in most patients, although a few seizure-free patients did experience improvement. Funding: none