Conference Coverage

Fine-Tuning the Ketogenic Diet May Benefit Children With Epilepsy—And Other News From the Child Neurology Society Meeting


AUSTIN—Adjusting the ketogenic diet is helpful in one of five children with epilepsy, researchers reported at the 2013 Annual Meeting of the Child Neurology Society.

“Medication adjustment and dietary modification lead to similar outcomes,” stated Eric Kossoff, MD, Assistant Professor of Neurology and Pediatrics at Johns Hopkins Children’s Center in Baltimore, and colleagues. “Therefore, both [tactics] can be tried if the ketogenic diet is not meeting seizure-control expectations.”

The findings are based on a retrospective review of 200 children with epilepsy who had begun the ketogenic diet at the Johns Hopkins Hospital between October 2007 and June 2013. Dr. Kossoff’s group identified 10 commonly implemented dietary and supplement changes among the children. The investigators also reviewed medication adjustments in the children, as well as patient records during the course of adherence to the ketogenic diet for as many as four interventions per child. Greater than 50% seizure reduction after a change was defined as success, according to the study authors.

A total of 156 children (78%) had at least one intervention, and 391 distinct and occasionally concurrent interventions were recorded, of which 265 were made specifically for seizure control, noted Dr. Kossoff.

“Overall, there was an 18% chance that any intervention would be successful, but only a 3% chance of resultant seizure freedom,” reported the researchers. “The likelihood of success did not decrease with each subsequent intervention. There was a trend toward medication adjustments being more successful than dietary modifications (24% vs 15%, respectively).”

Analgesic Overuse May Worsen Chronic Post-Traumatic Headaches in Adolescents With Concussion
Excessive use of analgesics may exacerbate post-traumatic headaches among adolescents who have had a concussion, investigators reported.

“Analgesics should be minimized or discontinued when headaches continue several weeks following concussion,” recommended Geoffrey L. Heyer, MD, of the Division of Pediatric Neurology, Nationwide Children’s Hospital in Columbus, Ohio, and colleagues.

The researchers conducted a retrospective review of 104 adolescents with concussion who had been referred to a pediatric headache clinic for chronic post-traumatic headaches of three to 12 months in duration. The study authors compared concussion symptoms, headache symptoms before and after concussion, demographic data, and headache outcomes between patients who had probable medication-overuse headache and those who did not have probable medication-overuse headache.

A total of 77 patients had chronic post-traumatic headache between three and 12 months, and 54 patients (70%) met the criteria for probable medication-overuse headache. The investigators found that patients with medication overuse were more likely to have had daily headaches, to be female, to have had nausea or throbbing associated with their headaches, to have had increased irritability following concussion, and to have had a longer interval between injury and neurologic evaluation.

“Of the patients with medication overuse, 37 (68.5%) had resolution of headaches or improvements to preconcussion headache patterns after discontinuing analgesics, seven (13%) had no change in headaches or worsening of headaches after discontinuing analgesics, and 10 (18.5%) did not discontinue analgesics or were lost to follow-up,” stated Dr. Heyer.

2010 McDonald Criteria Are Effective for Early Diagnosis of Pediatric MS
The 2010 Revised McDonald Diagnostic Criteria for Multiple Sclerosis (MS) may have a higher sensitivity for diagnosing pediatric MS, compared with the 2005 criteria. The revised criteria thus could allow for earlier initiation of disease-modifying therapy, researchers reported.

Mitchel T. Williams, MD, Pediatric Neurologist at the Children’s Hospital of Michigan in Detroit, and colleagues conducted a retrospective study of 25 children who had been diagnosed with MS at the Children’s Hospital of Michigan from 2005 through early 2013.

The researchers applied the 2005 and 2010 McDonald criteria based on neuroimaging findings as well as initial clinical presentation. The investigators also analyzed demographic data and compared those data with those of previous pediatric MS cohorts.

The median age at presentation, sex ratio, clinical symptoms, and relapse rate among the participants were comparable to those in previously published data, except for a high rate of African Americans (64%) among the 25 children.

The researchers found that the initial MS diagnosis rate based on the 2005 McDonald criteria was 32%, compared with a rate of 92% using the 2010 McDonald criteria. The mean time after initial symptom presentation until the 2005 criteria for MS were met was 5.0 months, compared with 0.7 months for the 2010 McDonald criteria.

“[Our findings] suggest that the 2010 McDonald criteria are a more appropriate tool for the timely diagnosis of pediatric MS,” concluded the researchers.

Colby Stong

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