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(Abst. 2.300), 2018

Ketogenic Diet Prevents Relapse in Infantile Spasms With Structural and Genetic Etiology
Authors: Jacqueline Wolak, Lurie Children's Hospital of Chicago; Sunita N. Misra, Ann & Robert H. Lurie Children's Hospital of Chicago; Robyn Blackford, Lurie Children's Hospital of Chicago; Wesley Lowman, Lurie Children's Hospital of Chicago; Breanne Fisher, Lurie Children's Hospital of Chicago; and John J. Millichap, Lurie Children's Hospital of Chicago
Content: Rationale: In the United States, adrenocorticotropic hormone (ACTH) and vigabatrin are first-line therapies for patients with infantile spasms (IS). However, IS and other seizure types are often refractory to pharmacological and surgical treatments in patients with IS of focal-structural and genetic etiologies. Thus, research has focused on the important task of identifying alternative safe and effective therapeutic options for this population. Ketogenic diet therapies are evidence based treatments proven to reduce seizures in children and adults with intractable epilepsy, often started alongside other pharmacological treatments for seizures. At our center, all patients with IS are treated according to a standardized clinical pathway with ACTH, vigabatrin, or a combination of both medications followed by the option of the classic ketogenic diet (KD). This study was completed to examine the efficacy of the classic KD in preventing IS relapse and seizure occurrence in patients with IS. Methods: A retrospective chart review and data collection was completed for patients with IS treated and monitored in the Infantile Spasms Clinic at a tertiary medical center. Epilepsy etiology was categorized into known etiology (focal-structural or genetic cause) and unknown etiology. Patients were categorized into those who were treated with the classic KD and those who did not start the classic KD. IS relapse and other seizure occurrence were quantified through parental report and confirmed by video EEG. Results: A total of 46 patients were identified for this study. 32 patients with IS of known etiology were identified. 18 of these patients were treated with the classic KD and 14 of these patients were not treated with the classic KD. We found a statistically significant decrease in IS relapse from patients with IS of known etiology who were treated with the classic KD (Chi Square, 6.41, p < 0.05) compared to patients with IS of known etiology who did not start the classic KD. However, there was no statistically significant decrease in other seizure type occurrence rates in patients with IS of known etiology who were treated with the classic KD (Chi Square, 0.24, p < 0.1).17 patients with IS of unknown etiology were identified. 6 of these patients were treated with the classic KD and 11 of these patients were not treated with the classic KD. We found no statistical significance in IS relapse (Chi Square, 0.58, p Conclusions: The classic KD is a safe and effective therapy to prevent IS relapse in patients with focal-structural and genetic etiologies. However, the classic KD does not significantly prevent the occurrence of other seizure types in patients with IS with focal-structural and genetic etiology. Thus, although the classic KD may prevent IS relapse, these patients will need to be monitored for other seizure types. The classic KD had no significant impact on preventing relapse or seizure occurrence in patients with IS of unknown etiology. However this population is less likely to have IS relapse or seizure occurrence overall. Funding: Not applicable