Abstracts

Rationale: Classic Ketogenic diet (KGD) is now gaining more popularity for the treatment of drug resistant epilepsy (DRE) even in the developing countries. It is a common practice to admit the patients for three to five days in the hospital for KGD initiation considering the possibility of serious adverse events (AE). But admission in the hospital can be inconvenient for the parents and increase the health care costs. We aimed to look at the incidence of potential AE during the KGD initiation admission to see if there is a possibility of initiating the KGD safely at home. Methods: We performed a retrospective study of children with DRE who were admitted electively for five days for KGD initiation at King Fahad Specialist Hospital Dammam (KFSHD) in Saudi Arabia from 2011 to 2019. Records were reviewed for patient demographics, KGD characteristics, antiepileptic medications and AE during the admission. Our protocol did not include fasting before admission. AE during the admission were reviewed. We also looked at any predisposing factors which could lead to AE. Categorical data were analyzed using a Pearson’s chi-square test. Numerical data were analyzed using a two-tailed t-test with unequal variance. SPSS software (version 22.0; SPSS Inc., Chicago, Illinois, USA) was used to perform the statistical analysis. Significance level for all tests was p = 0.05. This study was approved by the KFSHD Review Board. Results: A total of 59 children (56.9% female) were included, with the mean age of 47.2 months. Potential AE occurred in 15 children (25.4%) (Table 1), which include hypoglycemia, hypoactivity, somnolence and vomiting (Figure. 1). There was significant difference among gender (p=.043), weight (p=.005) and age (p=.053) in AE and no AE group (Table 1). In AE group, reported AE occurred more in children with age less than three years old (Figure 2). There was no significant difference for HCO3 level (mmol/L) at baseline and after 3rd day of KGD initiation among two groups (Figure 3). Hypoglycemia at any time during the admission occurred in 10 (52%); somnolence 2 (10.5%), vomiting 4 (21%) and hypoactivity 3 (15%) (Figure 1). AE during KGD initiation also correlated with concurrent use of topiramate (60%) (p=0.046, Figure 4) especially in male group (100%). These AE were treated with simple interventions and did not require discontinuation of KGD. Conclusions: The incidence of AE during the KGD initiation admission in low. Female gender, low body weight, age less than three years, and concurrent use of topiramate could be predisposing factors for AE. The AE can be usually managed with simple interventions. With good education and close communication with parents, there may be a possibility of initiating KGD at home in carefully selected patients. This could allow the large scale use of KGD especially in developing countries where patients cannot bear hospital admission costs and not all expensive treatment options are available. Funding: No funding