Abstracts

Rationale: Ketogenic diet (KD), Modified atkins diet (MAD), and low glycemic index treatment (LGIT) are dietary therapy for intractable epilepsy. They are well known for seizure control and cognitive development. In particular, KD is composed of high fat, low carbohydrate, and adequate protein which are different from regular meals, and the physician regularly carries out follow-up management to control side effects. If necessary, the physician issue consultation to nutrition team for counseling such as ratio and/or calorie modification of dietary therapy, management of meal, etc. The purpose of this study is to determine when nutritional intervention is needed to maintain long-term dietary therapy. Methods: Among the 127 patients with intractable epilepsy who were receiving dietary therapy at the Severance Hospital in March 2017, total 109 patients were included in the study, exclusions are patients with tube feeding, patients with repeating initiation and withdrawal of dietary therapy. The period of duration, the ratio of nutrient composition, the nutritional status, and the number of consultation implemented by dietitian were collected via electronic medical records (EMR). The nutritional status were assessed by the z-score (weight by height) of the patients who were prescribed consultation to nutrition team. Results: The diet therapy duration of 109 children varied from 0 to 103 months. When categorizing the diet therapy duration by 12 months, total 38 patients (34.9%) were less or equal to 12 months, 36 patients were between 13 to 24 months, 13 patients were between 25 to 36 months, and gradually decreased as duration goes further.82 of the 109 patients were prescribed to consultation for nutritional counseling therefore dietitian was feasible to evaluate the nutritional status of patients. According to the nutritional status evaluation using z-score, 54 (65.9%) of 82 patients maintained the same level of nutritional status, 12 (14.6%) patients improved and 16 (19.5%) patients deteriorated. The most frequent consultation were implemented in the duration period of 13 to 18 months (17 patients, 21%). The patients who did not prescribed to meet the dietitian (27 patients, 24.8%) were in the duration of 0 to 6 months (13 patients, 48.1%), which is under the initial stage of dietary therapy. Conclusions: In the initial stage (0 to 6 months), nutrition counseling and Q & A can be freely done by caregiver using phone or e-mail even if nutrition team consultation is not prescribed. However, if the caregiver go through a period of adjustment, they loose necessity of contacting nutrition team. The number of follow-up was found to be the highest in the period between 13 to 18 months. In addition, dietitian can evaluate the patient's nutritional status continuously. In case of long-term maintenance of dietary therapy, periodic follow-up should be recommended to improve compliance and to evaluate nutritional status of the patient and furthermore nutritional intervention between 13 to 18 months is necessary.