Introduction: Epilepsy is a neurological disorder characterized by an increased susceptibility to seizures. The ketogenic diet (KD) is currently the most important alternative non-pharmacological treatment. Despite its long history of clinical use, it is not clear how this diet affects longitudinal growth in children. Methods: A prospective study was designed to evaluate growth and nutritional status in 45 children on KD. Growth was assessed by measuring weight, height, and body mass index (BMI). Standard deviation scores (SDS) were calculated for all measurement parameters at KD initiation and at a two-year follow-up. Results: Overall, 45 patients who completed 24 months on KD were enrolled. Median age was 6.6 years (0.8 to 17.3), with a male predominance (n = 23); 74% of the 45 patients were responders on seizure reduction at three months; 26% of patients were non-responders. In our study, using −1 SDS as a cut-off point, growth deceleration was observed in 9% (n: 4) of the patients; however, the nutritional status was maintained or even improved. No correlation with age, sex, or ambulatory status was found. Conclusions: The nutritional follow-up of these patients was helpful to improve overweight and thinness but could not avoid growth deceleration in some of them. These findings confirm that children with refractory epilepsy on KD treatment require careful growth monitoring.

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Aims . Epilepsy of infancy with migrating focal seizures (EIMFS) is a rare epilepsy syndrome, characterized by an onset of multifocal seizures before the age of six months and a rather typical ictal EEG pattern. The ketogenic diet (KD) has been shown to be a treatment option in these patients with variable results. The KD is generally given by enteral formula or solid food, however, patients on the KD often have coexisting medical disorders that may impair the gastrointestinal tract and, in these cases, parenteral nutrition support may be needed. We present our experience with three patients who had been on the KD because of EIMFS, who were acutely unable to absorb nutrients through the intestinal tract. Results . For these patients, we were unable to reach ketogenic ratios higher than 1.5:1 because of the limited fat intake via the parenteral route. This ratio, nevertheless, was adequate for maintenance of seizure control while allowing short‐term bowel rest. Conclusions . Even though our report is limited as it provides no controlled evidence, ketogenic parenteral nutrition should be considered in children on the KD when enteral nutrition is not feasible. Special care should be taken to maintain ketosis and avoid undesired carbohydrates. Patients may respond well to ketogenic parenteral nutrition in spite of a lower ketogenic ratio.

Ketogenic diet therapies (KDTs) are high-fat, low-carbohydrate, and moderate-protein interventions that have been used over the years to control seizures in patients with treatment-refractory epilepsy and certain inborn errors of metabolism. The mechanism of action of KDTs is thought to be related to molecular changes that are the result of increased systemic ketone-body concentration and decreased glucose levels leading to a reduction in seizure frequency. Therefore, systemic ketone bodies and glucose levels are measured daily in these patients. “My Keto Life” was developed as a dynamic and easy to use web- and App-based monitoring and support tool for epilepsy patients on KDTs. Using this eHealth tool patients are able to regularly record self-measured values, such as ketone bodies, glucose levels, and seizures, to monitor adherence and allow real-time intervention by physicians and nutritionists. Based on non-structured interviews with experts in metabolism, epileptologists, and nutritionists from the KDT team at Hospital Garrahan, Buenos Aires, Argentina, a suitable digital platform was designed and developed to improve care of epilepsy patients on KDTs. Daily self-tracking of ketone bodies and glucose levels, the dynamic recording of food intake, supplements, and antiseizure medications by users, real-time monitoring by and communication with physicians and nutritionists, and personalized reminders for taking anti seizure medications, supplements, and ketone measures are the most prominent features of this tool. “My Keto Life” is a rapid and iterative eHealth tool developed together with physicians and nutritionists for the adequate management of epilepsy patients on KDTs in order to promote patient engagement, facilitate monitoring by physicians, and optimize treatment leading to better therapeutic outcomes.