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Ketogenic Diet

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  Running head: KETOGENIC DIET 1 Efficacy of the Ketogenic Diet in Pediatric Epilepsy Hannah Stuart University of New Hampshire  KETOGENIC DIET 2 In pediatric patients who have epilepsy, what is the effect of a ketogenic diet on reducing the number of seizures they experience, compared to pharmacologic therapy alone? Background and Rationale Epilepsy is the most common neurological condition in the world. The ketogenic diet is a high fat, moderate protein, and low carbohydrate diet that may be used to treat epilepsy. The purposed of this diet is for the patient to achieve sustained ketosis. Ketosis leads to a reduction in seizure activity, but the mechanism of action is still unknown. This diet was discovered in the 1920’s , but Dilantin was discovered soon after, and the treatment of epilepsy turned to pharmacologic advances instead (Freeman, 2007). It is important for nurses to be aware of the evidence associated with a ketogenic diet in order to provide optimal nursing care to patients who have epilepsy. Search Methods To search for evidenced I used the CINAHL Complete Database. It is a database for nursing literature put out by EBSCOhost, and I accessed it through the University of  New Hampshire library system. The key words I used in my search were “ketogenic diet”, “ketosis”, “epilepsy”, “seizures”, and “pediatric” . Limiters I used were articles with full text only, English language, and published after the year 2000. After narrowing my results, I was able to find four articles that applied to my research question. The inclusion criteria I used were: the study needed to address the use of a ketogenic diet in the treatment of epilepsy, a sample size of at least twenty participants, and the age of  participants ranging between three months old and eighteen years old. Exclusion criteria  KETOGENIC DIET 3 were studies that included participants with seizures that were due to known metabolic causes, and studies that included participants over the age of eighteen years old. Critical Appraisal of the Evidence One study, published by the American Academy of Pediatrics, considered the long-tem outcomes of children with difficult-to-control seizures after starting the ketogenic diet. The study had 150 participants, and families responded to a survey before the child started on the diet, and then again three to six years after continuing the diet. The surveys included questions about the child’s general health, frequency of seizures, and the child’s current medications. Before the start of   the study, all participants had a minimum of two seizures a week and had failed to respond to two anticonvulsant medications. Only thirty children remained on the diet for over three years, for various reasons. Some participants stopped the diet because they became seizure free, others stopped because they were not seeing any improvement, and some because they found the diet too restrictive and hard to manage. At the end of the three to six year period, 27% of participants were either free of seizures or had at least a 90% decrease in the amount of seizures they were experiencing, and 19% were free of medications. Some of the strengths of this study included the fact that it was a prospective study, it had a large sample size, and the study included participants with seizures due to various causes. Another strength was that the researchers used the Johns Hopkins protocol for initiating the diet. The Johns Hopkins protocol, which includes hospitalization during the initiation, is the most widely adopted protocol and therefore eliminates variables due to differences in initiations. There were two weaknesses that I found in this study. One weakness was  KETOGENIC DIET 4 that the researchers only looked at children with intractable epilepsy, so it cannot be generalized to all pediatric patients experiencing seizures. A second weakness is that the data is based on a survey completed by the families, so it is subject to the parent’s opinions and estimations and not as reliable as quantitative data (Hemingway, 2001). Another study evaluated the use of the ketogenic diet in intractable childhood epilepsy due to focal malformation of cortical development. This was a retrospective study of 47 patients, from two different epilepsy centers, who were experiencing more than four seizures a month and were on at least three antiepileptic medications. The  patients were all candidates for surgery, but parents agreed to a trial of the ketogenic diet first. After three months, 61.7% of the patients had more than a 50% decrease in seizure frequency. The researchers used the classic ketogenic diet and designed their own  protocol for initiation, which they had published in a previous article. The participants were maintained on the diet for two years, and then were gradually taken off of the diet over four to six months. Out the participants that were free of seizures after three months, 47.6% remained seizure-free after the completion of the diet (average follow-up of three years and ten months). The outcomes of different age groups were similar, but the compliance with the diet was much better in younger children. A strength of this study is that the researchers considered differences in age to see if it was a variable. Weaknesses of this study were that they didn’t use t he Johns Hopkins protocol, they had a relatively small sample size, and the study was retrospective (Jung 2008). A third study I found evaluated the clinical records of pediatric patients with refractory epilepsy in Argentina who had been treated with a ketogenic diet. There were 216 patients used in the study. The researchers used patients who started the diet between
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