Abstracts

Rationale: Children with intractable epilepsy (IE) are at risk for medication side effects and continued seizure activity. Suboptimal growth and nutritional status are common. Cerebral palsy (CP) is a common comorbid diagnosis among children with IE and is known to be associated with low REE. A better understanding of the energy requirements in children with IE with and without CP may help minimize nutritional related side effects and optimize their care. The purpose of this study was to evaluate the resting energy expenditure (REE) of children with IE compared to age-matched controls and determine factors that contribute to differences in REE.Methods: A cross sectional study of REE and growth status was performed in prepubertal children with IE compared to healthy children matched for age, gender and fat free mass (FFM). Children with IE were subdivided into those with and without cerebral palsy (CP). REE (kcal/day) was measured by indirect calorimetry and expressed as percent predicted using Schofield equations. Energy intake from 3 day weighed food records was assessed for children with IE only and expressed as percent estimated energy requirement (%EER)for low active children. Statistical analysis included descriptive analysis, students T-test, Wilcoxon rank sum, and multiple regression analyses.Results: 25 Children with IE (15 males, 5.4±2.2 years) was compared to 75 healthy children (43 males, 6.3±1.7 years). Children with IE were younger, had significantly poorer weight and BMI status, lower FFM and FM and lower REE compared to healthy children (-7% predicted, p<0.05). Their energy intake was suboptimal with 65% below EER for low active children. Children with IE and CP had particularly poor growth status, lower weight, height, body mass index (BMI) z-score, FFM and fat mass (FM) and REE compared to healthy children (-13% predicted,p<0.005). There was a trend (p<0.1) towards lower energy intake compared to children with IE without CP. REE adjusted for FFM, FM and gender was significantly lower in children with IE and CP (-110 kcal/day, p=0.02), and tended to be lower in children with IE without CP as well (-42 kcal/day). FFM, gender and CP were significantly associated with REE and explained 60% of the variance. In children with IE, CP, FFM and energy intake significantly predicted the REE and explained 56% of the variance.Conclusions: CP largely explained the suboptimal growth status and lower REE of children with IE compared to healthy controls. In children with IE lower REE was associated with reduced energy intake. These results suggest that the growth faltering in children with IE is not due to excessive energy expenditure and would likely respond to increased caloric intake. Future nutritional and behavioral interventional studies are needed to determine the impacts of increased caloric intake on growth and other health outcomes in children with IE.