Pediatric Epileptologists Research Articles

SVD Square-root Iterated Extended Kalman Filter for Modeling of Epileptic Seizure Count Time Series with External Inputs.

In this paper a nonlinear filtering algorithm for count time series is developed that takes the non-negativity of the data into account and preserves positive definiteness of the covariance matrices of the model. For this purpose, a recently proposed variant of Kalman Filtering based on Singular Value Decomposition is incorporated into Iterative Extended Kalman Filtering, in order to estimate the states of a nonlinear state space model. The resulting algorithm is applied to the evaluation and design of therapies for patients suffering from Myoclonic Astatic Epilepsy, employing time series of daily seizure rate. The analysis provides a decision whether for a specific patient a particular anti-epileptic drug is increasing or reducing the seizure rate. Through a simulation study the proposed algorithm is validated. Additionally, for clinical data results obtained by the proposed algorithm are compared with the results from a Cox-Stuart trend test as well as with the visual assessment of experienced pediatric epileptologists.

Association of Child Neurology-Indian Epilepsy Society Consensus Document on Parental Counseling of Children with Epilepsy.

When a child is diagnosed with epilepsy, counseling regarding the same is done by the treating doctor. Most parents are frightened and have poor knowledge about epilepsy. Therapeutic advice including drug dosage, administration and side effects takes up the major part of physician's time, thereby neglecting important issues like home seizure management, follow up and others.These lacunae in knowledge require systematic patient and family education. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators, legal experts, parents, and teachers was held. The various aspects regarding parental counseling in children with epilepsy were discussed and a consensus document was formulated. Here authors present the group consensus statement on counseling parents and caregivers of children with epilepsy. This document is intended to help physicians and pediatricians counsel the families when a child is diagnosed with epilepsy.

Association of Child Neurology-Indian Epilepsy Society Consensus Document on Social and Legal Aspects of Childhood Epilepsy (SOLACE).

Epilepsy is a chronic neurological disorder which affects not only the health of the affected child, but also has an economic, psychological and emotional impact on the family as a whole. In the transition from Person with Disability (PWD) act (1995) to Rights of Persons with Disabilities act (RPWD act) (2016), which covers all aspects of life of a person with any disability, epilepsy has been excluded from the list of disorders, resulting in a loss of many of the benefits that were earlier available to persons with epilepsy, causing concern to all caregivers of persons with epilepsy. Additionally, physicians/ pediatricians/ neurologists are not really aware of the benefits that are available to persons with epilepsy, especially children. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators legal experts, parents, and teachers was held. The implication of epilepsy being dropped as a disability, was discussed, and most of the experts concurred that epilepsy should be considered as a disability, depending of the type of seizures or the epilepsy syndrome. Also, the current status of income tax benefits, child care benefits, travel concession, schooling and health insurance for children with epilepsy in India were also discussed. The importance of creating awareness on these issues was stressed on. Here authors present the group consensus statement on these legal and social aspects about the care of children with epilepsy.

Pioneers and Emerging Pediatric Neurologists and Epileptologists in the World

Pioneers and Emerging Pediatric Neurologists and Epileptologists in the World

Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force.

The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system.

Epilepsy services in Saudi Arabia

Objective:To assess the epilepsy services and identify the challenges in hospitals without epilepsy monitoring units (EMUs). In addition, comparisons between governmental and private sectors, as well as between regions, are to be performed.Methods:A cross-sectional study conducted using an online questionnaire distributed to the secondary and tertiary hospitals without EMUs throughout the Kingdom of Saudi Arabia (KSA). The study was conducted from September 2013 to September 2015 and regular updates from all respondents were constantly made. Items in the questionnaire included the region of the institution, the number of pediatric and adult neurologists and neurosurgeons along with their subspecialties, the number of beds in the Neurology Department, whether they provide educational services and have epilepsy clinics and if they refer patients to an EMU or intend to establish one in the future.Results:Forty-three institutions throughout the Kingdom responded, representing a response rate of 54%. The majority of hospitals (58.1%) had no adult epileptologists. A complete lack of pediatric epileptologists was observed in 72.1% of hospitals. Around 39.5% were utilizing beds from internal medicine. Hospitals with an epilepsy clinic represented 34.9% across all regions and sectors. Hospitals with no intention of establishing an EMU represented 53.5%. Hospitals that did not refer their epileptic patients to an EMU represented 30.2%.Conclusions:Epilepsy services in KSA hospitals without EMUs are underdeveloped.

What do epileptologists recommend about discontinuing antiepileptic drugs for a second time in children?

ObjectiveThere is a broad consensus that antiepileptic drugs (AEDs) may be withdrawn after two years of seizure freedom for most children with epilepsy. If seizures recur and are, again, completely controlled with AEDs, little is known about discontinuing a second time. We surveyed American and Canadian pediatric epileptologists to understand their current practice. MethodsIn 2014, a survey was sent via e-mail to 193 pediatric epileptologists to learn about AED discontinuation practices in children. The survey asked direct questions about practice and posed five “real-life” cases where the decision to discontinue might be difficult. Participants were identified through membership lists of several US and Canadian epilepsy organizations. ResultsThere were 94 (49%) completed surveys. Sixty-three participants had ≥10years in practice (“more experienced”: mean 23±9years), and 31 had <10years (“less experienced”: mean 6±2). Overall, 62% recommended AED discontinuation for the first time after 2–3years of seizure freedom, and 61% recommended discontinuation for the second time after 2–3years. Fifty-six percent of “more experienced” clinicians required a longer seizure-free period prior to a second discontinuation (p<0.001) compared with 26% of “less experienced” clinicians (p=ns). Overall, most participants suggested an AED taper duration of 2–6months for the first and second attempts, 52% and 68%, respectively. Both groups wean AEDs more slowly during the second attempt (p<0.001). There was only 40–60% agreement among participants to discontinue AEDs in four of the cases. ConclusionNearly half (46%) of pediatric epileptologists require a longer seizure-free period the second time they attempt to discontinue AEDs compared with the first attempt and wean down AEDs somewhat more slowly. Although a variety of factors influence decision-making, there was a high level of disagreement to discontinue AEDs a second time in “real-life” cases.

Imaging Spectrum of Cortical Dysplasia in Children

estimated that up to 30% of patients become resistant to optimized medical therapy and are potential surgical candidates. 2 Criteria for this distinction have varied, but most agree that failure of 2 appropriate antiepileptic drugs to adequately control seizures, with more than one seizure/month over an 18-month–2-year period, constitute intractability. 2 Additional important clinical features indicating that the patient may be a surgical candidate include stereotyped, lateralizing seizures with focality of semiology, a localized “epileptogenic zone” by scalp electroencephalography (EEG), magnetoencephalography (MEG), or surface EEG, and a localized anatomical target on magnetic resonance imaging (MRI). 2 In fact, the presence of an imaging abnormality is one of the key findings that predict resistance to medical therapy and may be a critical finding in determining suitability for surgical therapy. 3 Interestingly, it is thought by many pediatric epileptologists that younger children may in fact be better candidates for epilepsy surgery than adults because of their increased neuroplasticity and the detrimental effect of repeated seizures on normal neurologic development. 4 Cortical dysplasia is the most common neuropathology noted after surgical resection for intractable epilepsy in children, and recent clinicopathologic classification systems have had a significant effect on the treatment and understanding of this disorder. 5,6 Some forms of focal cortical dysplasia (FCD) (such as type IIb) have typical imaging manifestations, whereas other types such as isolated type I cortical dysplasia have variable and often nonlocalizing imaging features. As imaging findings indicating cortical dysplasia may significantly affect selection for potential surgery, radiologists involved with the workup of these patients must be familiar with the imaging spectrum of FCD, especially in children. In this article, we review the current pathologic classification and imaging findings in cortical dysplasia with an emphasis on the pediatric population.

Inherited Metabolic Epilepsies edited by PearlPhillip, 400 pp., Demos Medical, 2013, $95

edited by Phillip Pearl, 400 pp., Demos Medical, 2013, $95 While the inborn errors of metabolism account for a relatively small proportion of children with new-onset epilepsy, these disorders frequently cause progressive disability and are associated with other neurologic symptoms such as developmental delay or regression and motor or movement disorders. Early, accurate diagnosis is essential, as specific therapies beyond antiepileptic medication may be required to prevent progression of neurologic symptoms and afford seizure control. Furthermore, these disorders are inherited, mandating genetic counseling. This area of inherited metabolic disorders is one of the most complex, comprising a large number of disorders, which frequently require very specific testing to identify. Thus, Inherited Metabolic Epilepsies fills a much-needed niche and is a valuable addition to the library of pediatric epileptologists and child neurologists.

The Evolution of Dietary Therapy for Neurologic Disorders

In the 4 years since the first international symposium devoted to the ketogenic diet, held in Phoenix, Arizona, there has been a significant increase in research and interest in this unique therapy. Ketogenic diet centers have started in many countries throughout the world, including developing nations. Evidence for success using dietary treatment for adults has grown and led to adult epilepsy diet centers being formed in several academic institutions. The traditional ketogenic diet itself continues to evolve with now 4 unique diets (classic ketogenic, mediumchain triglyceride diet, modified Atkins diet, and low glycemic index treatment) as well as research leading to less restrictive, safer, and easier diets to use for all age ranges. What is perhaps most dramatic since the Phoenix meeting in 2008 has been the remarkable increase in interest among neurologists and physicians in the use of this metabolism-based therapy for conditions other than epilepsy. Research in the past 4 years has shown potential benefits of low-carbohydrate, highfat diets for diabetes, metabolic syndrome, Alzheimer disease, cancer, amyotrophic lateral sclerosis, to name a few. Specialists in these conditions often look to pediatric epileptologists familiar with the ketogenic diet for advice as they embark on clinical trials. Conversely, pediatric epileptologists are often reviewing the medical literature for advice on keeping patients healthy on low-carbohydrate diets, especially when long-term use is required. As a result, Drs Thiele and Thio and I, along with Beth Zupec-Kania and Jim Abrahams from the Charlie Foundation, as the 5 co-organizers of this Third Symposium on dietary therapy, thought it was the appropriate time for a unique conference. We wanted to make this conference different, bringing together experts from fields outside of epilepsy to share their knowledge and help create potential collaborations for the future. Now, as we publish this Special Issue detailing the proceedings of this spectacular conference, we believe we succeeded. This Special Issue will begin with the Thursday morning of the Symposium, chaired by Dr Adam Hartman, and focusing on the emerging neurologic, but nonepilepsy uses of dietary therapy including as well diabetic nephropathy and cancer. Before delving into these topics, Dr Helen Cross will discuss the highlights of the past 2 years regarding the ‘‘traditional’’ use of dietary therapies for epilepsy in children. Three multiauthor reviews will then cover the Thursday afternoon breakout sessions, devoted to nutritional aspects (Beth Zupec-Kania first author), basic mechanisms of action (Dr Liu Lin Thio), and the growing uses of diets for adults (Dr Mackenzie Cervenka). Friday morning’s lectures returned to the field of epilepsy, with presentations on Dravet syndrome, glucose 1 transporter deficiency, and status epilepticus. This Special Issue will then close with 2 final articles regarding the future implications of dietary therapies and a parent’s perspective on how to continue to make these exciting and helpful treatments more widely available. This meeting would not have been possible without the support of the Charlie Foundation as well as many sponsors including Nutricia, Chicago Sun-Times, Matthew’s Friends, Lundbeck, Vitaflo, Sigma-Tau, Epilepsy Therapy Project, Carson Harris Foundation, Athena, Atkins, Protocol for Life Balance, Epilepsy Cure Initiative, Solace Nutrition, Anita Kaufmann Foundation, Dravet Syndrome Foundation, Epilepsy Foundation Greater Chicago, Citizens United for Research in Epilepsy, Glucose Transporter 1 Deficiency Foundation, Intractable Childhood Epilepsy alliance, Lennox Gastaut Syndrome Foundation, Tuberous Sclerosis Alliance, Johns Hopkins Hospital, and LeBonheur Children’s Hospital. We also gratefully thank Gary Taubes and Matt Vanderheiden for their Wednesday evening keynote lectures. In addition, the inspirational speeches and involvement by Meryl Streep and Jeff Garlin at the Friday night gala reception helped bring this incredible meeting to an uplifting close. This Special Issue was supported and encouraged by Dr Roger Brumback, the EditorIn-Chief of the Journal of Child Neurology. Lastly, all of the organizers and speakers mourn the tragic loss of Dr Marwan Maalouf, the speaker on the topic of ketogenic diets and Alzheimer disease, who passed away shortly after this meeting. On behalf of the organizers and all the authors of these reviews, we hope you enjoy reading about this research as much as we valued hearing about it in Chicago. The ketogenic diet is certainly evolving, and this Special Issue demonstrates it. We are all excited to see where this evolution takes the diet over the next 2 years, leading up to the fourth international symposium in October 2014 in Liverpool, United Kingdom.

Psychiatric symptoms in children prior to epilepsy surgery differ according to suspected seizure focus

Children and adolescents with epilepsy have an overrepresentation of psychiatric illness. However, few studies in pediatrics have characterized specific psychiatric conditions associated with seizure localization. In addition, degree to which psychiatric illness may be more prominent in children refractory to standard medical treatment for epilepsy is not known. The aim of this study was to assess psychiatric symptoms in children with medically refractory epilepsy and ascertain whether symptoms were associated with specific localization. Case records were reviewed for 40 children with medically refractory epilepsy at the time of their referral for presurgical evaluation. Patients received a clinical psychiatric evaluation and parents completed the Child Behavioral Checklist (CBCL). Seizure localization was verified by pediatric epileptologists, and suitability for surgical procedures was verified by neurosurgical specialists. Groups were compared based on localization of seizure foci, either in the temporal lobe or predominantly extratemporal. The majority of the sample had psychiatric diagnoses and behavior problems, well beyond the level reported in chronic epilepsy populations. In addition, children with temporal lobe seizure foci had more CBCL behavioral problem categories rated in the clinically significant range, and also were more likely to have clinical diagnoses of depression. Routine psychiatric evaluation prior to epilepsy surgery may be important for pediatric patients with medically refractory epilepsy. Psychiatric illness, particularly depression, may be especially prominent for those with temporal lobe seizure foci.

In search of the Rosetta Stone for ESES

We read with interest the report by Sanchez Fernandez et al. (2012) describing a lack of a common language among North-American pediatric epileptologists regarding encephalopathy with electrical status epilepticus during sleep or continuous spike-and-wave during sleep (ESES/CSWS) and related conditions. In this paper, the authors suggested the use of ‘‘ESES’’ when referring to the EEG pattern, and ‘‘CSWS’’ when referring to the epileptic encephalopathy. However this suggestion was not supported by an explanation or by survey results. In our view, there is no reason to consider the term “ESES” as indicative of EEG pattern, or for “CSWS” as the syndrome. Indeed, “CSWS” is

Survey of current practices among US epileptologists of antiepileptic drug withdrawal after epilepsy surgery

In order to identify the current practices of antiepileptic drug (AED) withdrawal after epilepsy surgery, a survey was administered to 204 adult and pediatric epileptologists. The responses from 58 epileptologists revealed wide variations regarding the time course and extent of AED withdrawal after successful epilepsy surgery. For most of the epileptologists, the likelihood of the surgery being successful is an important factor in determining whether or not AEDs are tapered. Most of the respondents started to taper AEDs more rapidly than suggested by previous reports. The majority of the epileptologists were able to stop all AEDs completely in a substantial number of patients. The most important factors considered when deciding to taper AEDs were the presence of ongoing auras and the occurrence of postoperative seizures prior to seizure remission. In the absence of data from well-designed prospective trials, such survey results can inform practice and, hopefully, aid in the design of future trials.

The tower of Babel: Survey on concepts and terminology in electrical status epilepticus in sleep and continuous spikes and waves during sleep in North America

The terms "electrical status epilepticus during sleep (ESES)" and "continuous spikes and waves during sleep (CSWS)" have been used interchangeably when referring to related but different concepts. In addition, the quantification of epileptiform activity has not been standardized, and different approaches to quantification have been used. The aim of this study was to evaluate the extent to which pediatric neurologists and epileptologists use a homogeneous terminology and conceptualization in CSWS and ESES and to characterize the current understanding of these conditions. A survey addressing the use of terminology in "ESES" and "CSWS" and the understanding of related concepts was distributed online to all members of the Child Neurology Society and the American Epilepsy Society mailing lists. Surveys were self-administered and collected using an online survey website (http://www.surveymonkey.com). Two hundred nineteen surveys were completed, 137 from the Child Neurology Society mailing list and 82 from the American Epilepsy Society mailing list. ESES and CSWS were considered synonymous by 117 respondents, not synonymous by 61, 21 respondents did not know, and 20 did not respond. Most respondents (63.1%) considered CSWS as a devastating epileptic encephalopathy with severe sequelae even if treated correctly, but 25.1% of respondents indicated that it does not leave sequelae if epilepsy was treated early and another 11.8% noted that cognitive difficulties resolved with age. Cognitive and/or language regression were considered mandatory for the diagnosis of CSWS by only 27% of the respondents. The diagnosis of CSWS was based on electroencephalography (EEG) assessment alone by 31% of respondents. Respondents used different methods for calculation of the epileptiform activity, different EEG samples for calculation, and considered differently the lateralized epileptiform activity. The cut-off values for percentage of the sleep record occupied by spike-waves were variable depending on the respondent. There was no agreement on whether these cutoff values were mandatory for the diagnosis of ESES and CSWS. Our data show that the professionals caring for children with ESES and CSWS in North America use the terms, concepts, and defining features heterogeneously. The lack of a common language may complicate communication among clinicians and jeopardize research in this field. We anticipate that our data will fuel the development of much needed common terminology and conceptualization of ESES and CSWS.

Development and validation of the Pediatric Epilepsy Side Effects Questionnaire

To develop and validate a measure of antiepileptic drug (AED) side effects in children with a variety of seizure types, treatments, and therapy durations. Content for an initial 44-item measure was developed using the previously published Hague Scale and expert opinion from recognized pediatric epileptologists (n = 12) and caregivers of children with epilepsy (n = 21). The measure was completed by caregivers during routine clinic visits. Demographic and medical data were collected through chart reviews. Factor analysis was conducted and internal consistency, test-retest reliability, and construct validity were assessed. Questionnaires were analyzed from 495 children with epilepsy (M(age) = 10.1 years; range 2-21 years; 42% female; 14% African American; 32% new onset vs 68% chronic epilepsy). The final questionnaire, the Pediatric Epilepsy Side Effects Questionnaire (PESQ), is a 19-item measure with 5 subscales (i.e., cognitive, motor, behavioral, general neurological, and weight) that accounts for 99% of the variance. Internal consistency coefficients and test-retest reliabilities ranged from 0.72 to 0.93 and 0.74 to 0.97, respectively. Construct validity was demonstrated by increasing side effects as the number of drugs increased. Participants on valproic acid had significantly higher scores on the Weight Scale compared to those on carbamazepine. The PESQ is a reliable and valid measure of AED side effects in children across the epilepsy spectrum that can be used in both clinical and research settings.

Discontinuation of antiepileptic drugs after successful epilepsy surgery. A Canadian survey

To identify the perceived practice among Canadian epileptologists regarding discontinuation of antiepileptic drugs (AEDs) following successful resective surgery for temporal and extratemporal surgery. We performed a survey of pediatric and adult epileptologists in Canada, using a 77-item questionnaire to explore attitudes, timing, rate of withdrawal, and factors contributing to the decision to withdraw AEDs after successful epilepsy surgery. Surveys were mailed with a postage-paid return envelope. Two subsequent surveys were mailed to non-respondents at 15 days intervals. All procedures received institutional review board approval. Surveys were sent to 82 epileptologists in all the Canadian provinces. Sixty-six physicians answered the survey (80.5%), representing all epilepsy centers across Canada. The minimum seizure free period required after epilepsy surgery before withdrawing AEDs, varied substantially among responders: <6 months in 10%, 6-11 months in 21%, >1 year in 50%, >2 years in 12%, >2 years in 3% after. The most important factors influencing the decision to withdraw AEDs a negative EEG before discontinuation (71%), patients' preferences (78%) and the presence of unilateral mesial temporal sclerosis (70%). The most important factors against reduction were the following: patients' wishes to resume driving (67%), focal (65%) or generalized (78%) epileptiform activity on EEG after surgery, persistent isolated auras (78%), any seizures after hospital discharge (81%), and presurgical multifocal/bilateral/diffuse findings (78%). Canadian epileptologists indicated that AED levels, EEG and MRI are typically done before discontinuing AEDs. Generally, a good candidate for stopping AEDs has focal pathology, is completely seizure free, had an anterior temporal lobe resection, complete resection of seizure focus, and has no epileptiform discharges on postoperative EEG. The data pertaining to self-reported practice styles, and actual practice may differ.

Infantile Spasms: Treatment Challenges

Infantile spasms (IS) represent a major therapeutic challenge, as cessation of spasms and normalization of the electroencephalogram (elimination of hypsarrhythmia) are mandatory to prevent cognitive deterioration in previously healthy infants, or to preserve neurocognitive function among those neurologically affected prior to onset of IS. Traditionally, this epilepsy syndrome has been considered a "catastrophic" epilepsy, not only for its frequent refractoriness, but mostly due to its effect on cognition. Nevertheless, a change of attitude among pediatric epileptologists is probably warranted, as enough evidence and clinical experience demonstrate that early, aggressive therapy, especially with adrenocorticotropic hormone (ACTH), may not only lead to cessation of spasms, but often leads to the cure of infants with idiopathic/cryptogenic IS. Some ACTH protocols such as that prescribed in Israel (tetracosactide ACTH) appear to be highly efficacious in guarantying a good or even excellent prognosis in idiopathic IS. Moreover, oral prednisolone is a promising and much less expensive alternative to IM ACTH. Vigabatrin does have a role as a first-line agent, especially for tuberous sclerosis patients, but evidence supports hormonal therapy as the initial treatment. The role of pyridoxine and the ketogenic diet still needs to be established; given the efficacy of a much shorter tetracosactide ACTH protocol, there may be no need for the long-term diet, despite its efficacy. Finally, a very promising drug has been developed (CP-115) that may altogether replace the current therapeutic regimens in the near future.

Epilepsy in infancy

The selection of an antiepileptic drug (AED) for any patient with epilepsy is difficult, but selecting one for an infant with epilepsy is especially challenging. Pediatric neurologists and epileptologists struggle with the dearth of data to guide the selection of an AED in this population. In addition, most of the available studies are not randomized controlled studies meeting the criteria of a class I study.1 The possibility that AEDs may injure the developing brain further complicates the issue.2 Topiramate is one of the more frequently prescribed antiepileptic drugs for infants,3 though class I trials to support this practice are lacking.4,5 One factor accounting for its use in infants is its efficacy in treating various types of epilepsy in older populations. Randomized controlled class I studies support its use as adjunctive therapy for adults and children with refractory partial and generalized epilepsy4 and as monotherapy for adults and children older than 2 years with new-onset partial and generalized epilepsy.6,7 Second, in contrast to those AEDs that traditionally have …

Optimal clinical management of children receiving the ketogenic diet: Recommendations of the International Ketogenic Diet Study Group

The ketogenic diet (KD) is an established, effective nonpharmacologic treatment for intractable childhood epilepsy. The KD is provided differently throughout the world, with occasionally significant variations in its administration. There exists a need for more standardized protocols and management recommendations for clinical and research use. In December 2006, The Charlie Foundation commissioned a panel comprised of 26 pediatric epileptologists and dietitians from nine countries with particular expertise using the KD. This group was created in order to create a consensus statement regarding the clinical management of the KD. Subsequently endorsed by the Practice Committee of the Child Neurology Society, this resultant manuscript addresses issues such as patient selection, pre-KD counseling and evaluation, specific dietary therapy selection, implementation, supplementation, follow-up management, adverse event monitoring, and eventual KD discontinuation. This paper highlights recommendations based on best evidence, including areas of agreement and controversy, unanswered questions, and future research.

Commentary on “Optimal clinical management of children receiving the ketogenic diet: Recommendations of the international ketogenic diet study group”

The ketogenic diet (KD) is an established, effective nonpharmacologic treatment for intractable childhood epilepsy. The KD is provided differently throughout the world, with occasionally significant variations in its administration. There exists a need for more standardized protocols and management recommendations for clinical and research use. In December 2006, The Charlie Foundation commissioned a panel comprised of 26 pediatric epileptologists and dietitians from nine countries with particular expertise using the KD. This group was created in order to create a consensus statement regarding the clinical management of the KD. Subsequently endorsed by the Practice Committee of the Child Neurology Society, this resultant manuscript addresses issues such as patient selection, pre-KD counseling and evaluation, specific dietary therapy selection, implementation, supplementation, follow-up management, adverse event monitoring, and eventual KD discontinuation. This paper highlights recommendations based on best evidence, including areas of agreement and controversy, unanswered questions, and future research.