Changes in pediatric referrals after the 2009 ketogenic diet consensus recommendations.

BACKGROUND

In 2009, the International Ketogenic Diet Study Group published recommendations for children receiving ketogenic diet (KD) therapy for epilepsy. The document included a table listing epilepsy syndromes and conditions in which the KD has been particularly beneficial, hoping that physicians would refer children for the KD sooner.

PURPOSE

To measure the impact of these 2009 recommendations on referral practice, we compared children initiated on the KD at Johns Hopkins Hospital (JHH) 10 years before and after the recommendations.

RESULTS

Overall, children referred to the KD who met indications increased from the pre- to post-recommendation group, 44 % (112/256) to 69 % (175/255) (p < 0.001), with JHH neurologists specifically referring more frequently (10/112, 9 % to 58/175, 33 %) (p < 0.01). Referrals increased for Glut-1 deficiency (0 % to 2.4 %, p = 0.015), Dravet syndrome (0 % to 6.7 %, p < 0.01), Rett syndrome (0.4 % to 3 %, p = 0.018), and formula-fed only status (16 % to 31 %, p < 0.01). The chances of > 50 % seizure reduction for all children referred improved slightly between decades (56 % to 61 %, p = 0.30).

CONCLUSIONS

Following the 2009 recommendations, our study shows there was an increase in referrals for children with indications at our center. Referrals from neurologists at our own institution increased the most. Ketogenic diet efficacy improved slightly over time but did not reach significance.

Informations de copyright

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Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rebecca Stainman has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Eric H. Kossoff reports a relationship with Nutricia Clinical Nutrition that includes: board membership. Eric H. Kossoff reports a relationship with Bloom Science that includes: board membership. Eric H. Kossoff reports a relationship with Cerecin that includes: board membership. Eric H. Kossoff reports a relationship with Simply Good Foods that includes: board membership. Eric H. Kossoff reports a relationship with Vitaflo that includes: consulting or advisory. Eric H. Kossoff reports a relationship with Biocodex USA that includes: consulting or advisory. Zahava Turner reports a relationship with Nutricia Clinical Nutrition that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.