Abstracts

Rationale: Epilepsy and its treatment can result in increased emergency department (ED) visits and hospital admissions. Ketogenic therapy (KT) is a well-established treatment for those with drug-resistant epilepsy and has documented benefits in reducing these epilepsy-related visits. Like any epilepsy treatment, KT has adverse side effects. At Phoenix Children's all patients (non-urgent) are initiated outpatient. To enhance safety and optimize outpatient management of KT, a home monitoring program (HMP) was developed with the purpose to assess adverse effects, provide early intervention, and avoid an ED visit or hospitalization. The goal of this review is to observe if less ED and hospital admissions occur following implementation of HMP.

Methods: This is a retrospective chart review of children initiated on KT at Phoenix Children's between 2020-2021 before use of a HMP, compared to 2022-2023, after a HMP was implemented. Criteria for inclusion: 1) epilepsy was diagnosed and treated by a pediatric epileptologist prior to KT; 2) patients were treated with KT for ≥ 12 months in both groups. Patients admitted for non-epilepsy reasons (i.e. laceration, infection, surgery) were excluded. We compared the number of ED visits and hospitalizations during the first 12-months of children initiated on KT prior to the development of a HMP with a cohort of children who utilized the HMP at initiation of KT and continued for a 12-month period. Epilepsy-related admissions were defined as ED or hospital admissions related to seizures or complications from epilepsy treatments, including KT. The number of visits within 12 months following KT initiation was gathered for both groups.

Results: In the HMP group, 102 total visits were identified for 32 unique patients in 12 months following KT initiation. Of those, 64 visits were excluded, resulting in 38 visits involving 24 patients. In the non-HMP group, a total of 133 visits were identified for 38 distinct patients. Of those, 42 visits were excluded, resulting in 90 visits involving 32 patients. In the non-HMP group, there was an average of 2.8 visits per patient annually compared to 1.6 visits per patient in the HMP group. This represents a reduction of 1.2 visits (43% reduction) per patient annually.

Conclusions: In children with drug-resistant epilepsy, treatment with KT utilizing a HMP may reduce the number of epilepsy-related admits. A major limitation to this study is not being able to use patients as their own controls. Additionally, it is possible that our data underreports the number of ED visits and hospital admissions that may have occurred outside of Phoenix Children's as our data only includes visits within our health system. Further research is needed to extrapolate if HMP helps reduce epilepsy-related admissions following KT initiation.

Funding: No funding was received for this abstract.