Telemedicine- versus outpatient-based initiation and management of ketogenic diet therapy in children with drug-resistant epilepsy during the COVID-19 pandemic

Armeno, Marisa; Caballero, Eugenia Pérez; Verini, Antonella; Reyes, Gabriela; Galarza, N; Cresta, Araceli; Caraballo, Roberto

doi:10.1016/j.seizure.2022.03.023

Cited by 12 publications

(9 citation statements)

References 20 publications

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“…Some recent research showed that the COVID-19 pandemic can be a source of parental stress in parents of children and adolescents with various neuropsychiatric conditions, including epilepsy [ 33 , 34 ]. On the other hand, an observational study by Armeno and colleagues (2022) [ 35 ] did not highlight additional difficulties in managing the KD during the COVID-19 pandemic and supported the feasibility and safety of initiating and managing the KD by telemedicine. The authors explored the feasibility, effectiveness, and safety of the KD in children with drug-resistant epilepsy compared to a group of children followed by telemedicine (n = 18) and a group of children followed in an outpatient modality (n = 19).…”

Section: Discussionmentioning

confidence: 99%

The Ketogenic Diet in Children with Epilepsy: A Focus on Parental Stress and Family Compliance

et al. 2023

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(1) Background: The aim of our study was to evaluate parental stress after 6 and 12 months of a ketogenic diet, considering demographic and clinical variables (epilepsy type, epilepsy duration, seizure number, antiseizure medications, comorbidities, efficacy, and adverse events). (2) Methods: We consecutively enrolled 36 children aged between 3 and 10 years who had been diagnosed with various types of drug-resistant epilepsy and who were in therapy with a ketogenic diet for better seizure control. A standardized neuropsychological questionnaire (Parenting Stress Index–PSI) was administered to the parents evaluating parental stress at baseline (T0), after 6 (T1) months, and after 12 months (T2). (3) Results: After 6 and 12 months of dietary treatment, Parental Distress and Total Stress mean scores were statistically significantly increased. Post hoc analysis showed no significant changes in the scores between T0 and T1, although there was a significant increase between T1 and T2. We did not find statistically significant relationships between parental stress and the other variables considered. (4) Conclusion: The ketogenic diet can be challenging for parents and can affect the perception of parental stress, especially in the long term. Parents may feel inadequate in their role; therefore, they should be helped and encouraged through additional supports in order to maximize the adherence to diet therapy.

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Section: Discussionmentioning

confidence: 99%

The Ketogenic Diet in Children with Epilepsy: A Focus on Parental Stress and Family Compliance

et al. 2023

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“…The KD is usually initiated during hospitalization, and patients are closely monitored under expert guidance, especially in cases of infants and children with severe co-morbidities ( 16 ). The 2019 coronavirus disease (COVID-19) pandemic and the associated lock-down measures have certainly affected children with epilepsy, particularly those who are candidates for KD ( 17 ), as a result, inpatient KD initiation has been sharply restricted ( 18 ). Therefore, continuing a specific diet during the COVID-19 pandemic is expected to be difficult in some aspects ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of the efficacy and safety of inpatient and outpatient initiation of KD for the treatment of pediatric refractory epilepsy using generalized estimating equations

Hao

et al. 2023

Front. Neurol.

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ObjectiveTo compare the efficacy and safety of inpatient and outpatient initiation ketogenic diet (KD) protocol of pediatric refractory epilepsy.MethodsEligible children with refractory epilepsy were randomly assigned to receive KD with inpatient and outpatient initiation. The generalized estimation equation (GEE) model was used to analyze the longitudinal variables of seizure reduction, ketone body, weight, height, body mass index (BMI), and BMI Z-score at different follow-up times between the two groups.ResultsBetween January 2013 and December 2021, 78 and 112 patients were assigned to outpatient and inpatient KD initiation groups, respectively. There were no statistical differences between the two groups based on baseline demographics and clinical characteristics (all Ps > 0.05). The GEE model indicated that the rate of reduction of seizures≥50% in the outpatient initiation group was higher than that of the inpatient initiation group (p = 0.049). A negative correlation was observed between the seizure reduction and blood ketone body at 1, 6, and 12 months (all Ps < 0.05). There were no significant differences in height, weight, BMI, and BMI Z-score between the two groups over the 12-month period by the GEE models (all Ps > 0.05). Adverse events were reported by 31 patients (43.05%) in the outpatient KD initiation group and 46 patients (42.20%) in the inpatient KD initiation group, but these differences were not statistically significant (p = 0.909).ConclusionOur study shows that outpatient KD initiation is a safe and effective treatment for children with refractory epilepsy.

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“…Our search in the MEDLINE database identified 11 articles eligible for title and abstract screening. As two articles did not provide original research data or specific concepts, further assessment was performed for 9 studies that were published between 2012 and 2023 and originated from Argentina (n=2) [9,10], USA (n=2) [11,7], Italy (=3) [12,13,14], Brazil [15], and the United Kingdom [16]. Armeno et al published an observational study with the aim to explore feasibility, effectiveness and safety of online guided KDT initiation and follow up versus standard outpatient KDT.…”

Section: Resultsmentioning

confidence: 99%

“…The use of Zoom TM , WhatsApp TM , e-mail and telephone was considered as telemedicine approach in the intervention group. Telemedicine was considered feasible and there was no difference between both groups regarding safety and effectiveness [9]. Semprino et al conducted a questionnaire-based survey to assess parent satisfaction with telemedicine guided KDT management.…”

Section: Resultsmentioning

confidence: 99%

Telemedicine for Ketogenic Dietary Treatment in Refractory Epilepsy and Inherited Metabolic Disease: State of Play and Future Perspectives

Höller,

Welte,

Schönlaub

et al. 2024

dHealth 2024

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Ketogenic dietary therapies (KDT) are diets that induce a metabolic condition comparable to fasting. All types of KDT comprise a reduction in carbohydrates whilst dietary fat is increased up to 90% of daily energy expenditure. The amount of protein is normal or slightly increased. KDT are effective, well studied and established as non-pharmacological treatments for pediatric patients with refractory epilepsy and specific inherited metabolic diseases such as Glucose Transporter Type 1 Deficiency Syndrome. Patients and caregivers have to contribute actively to their day-to-day care especially in terms of (self-) calculation and (self-) provision of dietary treatment as well as (self-) measurement of blood glucose and ketones for therapy monitoring. In addition, patients often have to deal with ever-changing drug treatment plans and need to document occurring seizures on a regular basis. With this review, we aim to identify existing tools and features of telemedicine used in the KDT context and further aim to derive implications for further research and development.

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Telemedicine- versus outpatient-based initiation and management of ketogenic diet therapy in children with drug-resistant epilepsy during the COVID-19 pandemic

Cited by 12 publications

References 20 publications

The Ketogenic Diet in Children with Epilepsy: A Focus on Parental Stress and Family Compliance

The Ketogenic Diet in Children with Epilepsy: A Focus on Parental Stress and Family Compliance

Analysis of the efficacy and safety of inpatient and outpatient initiation of KD for the treatment of pediatric refractory epilepsy using generalized estimating equations

Telemedicine for Ketogenic Dietary Treatment in Refractory Epilepsy and Inherited Metabolic Disease: State of Play and Future Perspectives

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