Diagnosis and Treatment

​​NATIONAL COORDINATING CENTER for EPILEPSY
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​Diagno​sis and Treatment

​​Early identification of the type of epilepsy and the type of seizures is important as it often influences treatment, outcome, and long term neurological prognosis. Click to view more about the variety of seizure disorders from the Epilepsy Foundation and Pediatric Care Online.4,5  For more information about Infantile Spasms, a specific type of seizure disorder, visit the AAP Diagnosis and Management of Infantile Spasms page. When a child is presenting with a seizure, a medical history and thorough description of the event are recorded. Often, routine lab work is performed in addition to imaging such as an electroencephalogram (EEG). 

Please note that inclusion on this webpage does not imply endorsement and/or recommendation by the American Academy of Pediatrics for any of the following treatments/tools. ​

    Nutrition

    The ketogenic diet (KD) is an adjunctive treatment for CYE with refractory epilepsy that dates back to 19216. A true KD is high fat, low carbohydrate and induces ketone body production through fat metabolism to induce a fasting, ketogenic state in the body. For CYE from whom the diet is indicated, “20-40% of  those treated with the KD reportedly showed a >90% reduction in seizure frequency, and a further 20%–60% showed a  >50% improvement”7. Studies have shown that “30%-60% of patients with drug resistant epilepsy who use the KD have at least a 50% reduction in seizure frequency at 6 months”7.

    The KD diet is a combination of the classic ketogenic diet, medium chain triglyceride (MCT) diet the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT)6:

    It is considered the first line of treatment for6:

    • Glucose transporter type I deficiency 

    • Pyruvate dehydrogenase deficiency

    KD has shown good efficacy, but is not considered the first line of defense for:

    • Infantile spasms

    • Rett syndrome

    • Dravet syndrome

    • Doose syndrome

    • Lennox-​Gastaut syndrome

    • Other childhood epilepsy syndromes

    The KD is considered part of a medical management plan and may work on select CYE that continue to have seizures despite appropriate medical treatment8A KD should not be attempted without medical supervision; CYE who are treated with the KD should have care through an epilepsy center specializing in the diet.​​​

    Ketogenic Diet Side Effects​

    Patient monitoring for dehydration and metabolic disturbances (ketoacidosis and electrolyte imbalances) is indicated and adverse events from the KD may include kidney stones, constipation, elevated cholesterol, and bone demineralization after prolonged periods of diet adherence7,8. A strict restriction of candy and sweets can prove difficult for both the CYE and the family. Children on a KD must be checked by the pediatric neurologist and registered technician to monitor for nutritional deficiencies, growth and diet adherence9,10. Follow-up visits to measure height and weight are indicated, along with blood and urine test. 

    Special considerations need to take place regarding the implementation of the diet and children with comorbidities​.​

The Coordinating Center is a cooperative agreement between the Maternal and Child Health Bureau (MCHB) and the American Academy of Pediatrics (AAP) to establish a multifaceted community-based system of care that ensures that Children and Youth with Epilepsy (CYE) have access to the medical, social, and other supports and services that they require to achieve optimal health outcomes and improved quality of life. This Web site is funded by the US Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA).​
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