The evidence base for the efficacy of the ketogenic diet was assessed among pediatric epileptic patients by application of a rigorous statistical meta-analysis. Nineteen studies from 392 abstracts met the inclusion criteria. The sample size was 1084 patients (mean age at initiation 5.78 ± 3.43 years). The pooled odds ratio, using a random effects model, of treatment success (> 50% seizure reduction) among patients staying on the diet relative to those discontinuing the diet was 2.25 (95% confidence interval = 1.69—2.98). The reasons for diet discontinuation included < 50% seizure reduction (47.0%), diet restrictiveness (16.4%), and incurrent illness or diet side effects (13.2%). The results indicate that children with generalized seizures and patients who respond with > 50% seizure reduction within 3 months tend to remain on the diet longer. Although no class I or II studies have been published regarding the efficacy of the ketogenic diet, this meta-analysis shows that current observational studies reporting on the therapeutic effect of the ketogenic diet contain valuable statistical data. Future observational studies should aim for long-term follow-up, patient dropout analysis, and improved seizure type characterization. ( J Child Neurol 2006;21:193—198; DOI 10.2310/7010.2006.00044).

The purpose of this study was to develop and test the psychometric properties of a Seizure Self-Efficacy Scale for Children (SSES-C). An initial pool of test items was generated using a variety of resources, including literature reviews, child self-efficacy measures from other chronic diseases, and self-efficacy measures for adult patients with epilepsy. Experts in the field of self-efficacy, chronic illness self-management, and behavioral management of seizure disorders were asked to evaluate item content and readability. The scale was administered via computer-assisted telephone interviews to 175 children ages 9 through 14 years who had had epilepsy for 6 months or more. Content validity of the SSES-C was ensured by 80% agreement on test items by experts. The final version of the scale has 15 items. Construct validity was supported by factor analysis and correlation of the SSES-C to other constructs of influence on the health behavior of children with epilepsy. Specifically, the SSES-C was significantly correlated with attitude toward illness, worry, unmet needs for psychosocial care, child depression, and child self-concept. Internal consistency reliability for the CHILDREN'S HEALTH CARE, 31(4),[295][296][297][298][299][300][301][302][303][304][305][306][307][308][309]

Purpose: To determine the independent contribution of population socioeconomic and health system factors on childhood cancer survivors' medical care and screening. Methods: 7899 childhood cancer survivors in the United States and Canada enrolled in the Childhood Cancer Survivor Study (CCSS). Population-level factors were derived from U.S. Area Health Resource File or 201 Canadian Census. Health service utilization and individual-level factors were self-reported. Multivariable logistic regression was used to calculate the effect of population factors on medical care (any care vs. no care; risk-based care vs. general care) and indicated echocardiogram or mammogram, adjusting for individual sociodemographic and health status. Results: After adjusting for individual factors, population factors had a nominal impact on childhood cancer survivors' medical care and screening. Higher population median income was associated with risk-based survivor-focused care versus general care (odds ratio [OR] 1.05, 95% confidence interval [CI], 1.01-1.09) among all participants, but not among U.S. residents only (OR 1.03, 95% CI, 0.99-1.07). For U.S. residents, the number of CCSS centers within the geographic area was associated with greater odds of receiving risk-based survivor-focused medical care (OR 1.12, 95% CI, 1.04-1.20). Areas with higher median income had higher rates of echocardiogram screening among survivors at risk of cardiomyopathy (for every $10,000 increase in median income, there is a 12% increase in odds of echocardiogram screening; 95% CI 1.05-1.20). A positive relationship was identified between greater number of physicians and surgeons in the county of residence and recommended echocardiogram (for every additional 1000 physicians and surgeons: OR 1.12, 95% CI, 1.01-1.23). We found no association between population-level factors and mammography screening. Conclusions: Population socioeconomic disparities moderately affect childhood cancer survivors' risk-based medical care and screening after accounting for individual sociodemographic and health factors.

Summary:Purpose: To use available evidence and expert consensus to develop performance indicators for the evaluation and management of pediatric epilepsy.Methods: We used a three-step process to develop the performance indicators. First, research findings were compiled into evidence tables focusing on different clinical issues. Second, an advisory panel of clinicians, educational and public health experts, and families of children with epilepsy reviewed the evidence. The advisory group used the evidence to draft a preliminary set of performance indicators for pediatric epilepsy management. Third, 13 internationally recognized experts in pediatric neurology or epilepsy rated the value of these indicators on a 5-point scale [1 (essential) to 5 (not necessary)] in a two-round Delphi process. Positive consensus was reached if ≥80% of experts gave an indicator a "1" rating and negative consensus if >80% gave an indicator a "5" rating. Indicators that achieved positive consensus during either round of the Delphi process constituted the final set of indicators.Results: Of the 68 draft performance indicators, the expert panel members achieved positive consensus on 30 performance indicators: eight indicators related to diagnostic strategies and seizure classification, nine related to antiepileptic drug use, six related to cognitive and behavioral issues, six related to quality of life, and three related to specialty referrals.Conclusions: We identified 30 potential indicators for evaluating the care provided to pediatric patients with epilepsy. The next step is to examine the relation of these performance indicators to clinical outcomes and health care utilization among pediatric patients with epilepsy.

We assessed pediatrician awareness of the parameter ''Evaluating the first non-febrile seizure in children'' and how the concepts of this parameter were incorporated into practice. Although most reported caring for children with seizures, 60% were not aware of the practice parameter. When given the clinical scenario of an otherwise healthy 8-year-old child with a first, unprovoked seizure, management was variable. Most (83%) would obtain an electroencephalography, and many (58%) would order an imaging study, usually a magnetic resonance imaging. However, most were also likely to order laboratory studies that were not indicated given the scenario and the practice parameter. This pilot study suggests that pediatricians may not be aware of this practice parameter and many may not be incorporating evidence-based recommendations regarding the evaluation of children with new-onset seizures.