Samenvatting

Introduction: The ketogenic diet can be used for the treatment of intractable epilepsy. This is a high fat, low protein and carbohydrate diet. There has been little research into the ketogenic diet for children under the age of 2. For infants it is expected that, due to development combined with frequent illness and the goal of maximal efficacy, the diet must be adjusted frequently. The following question will be answered in this thesis: What determinants are reasons for dietary adjustments and how effective are these adjustments, in short (0-3 months) and long-term (3-6 months) after the initiation of the ketogenic diet in infants 0-2 years of age treated for intractable epilepsy in the Erasmus MC Sophia Children’s Hospital? Methods: In this retrospective study infants treated with the ketogenic diet for intractable epilepsy were followed for three to six months after diet initiation. For each patient a case report form was filled out containing information on patient characteristics and determinants for fine-tuning and effectiveness. Chi-square tests were done to determine if there were more changes in short-term or long-term and if changes were more effective. Results: In total 45 patients were included in the study. The diet was adjusted 454 times for 43 different determinants. Overall the diet was mostly fine-tuned for the category Development. In both short and long-term, the diet was most often adjusted for growth, illness and high ketosis. The number of changes was significantly different for illness (p=0.043) and high ketosis (p=0.006). In both T1 and T2, growth and illness were significantly different in effectiveness (p=0.00). In T2, development was also significantly different (p=0.001) Conclusion: The study confirms the expectancy that development is often reason for dietary adjustments. In both short and long-term growth, illness and high ketosis were adjusted for most often. There was a significant difference in effectiveness for the determinants growth and illness. Implementing medicine as primary treatment for gastrointestinal problems could improve overall treatment. A do’s and don’ts list could be compiled for the dietary changes to improve overall effectiveness. Possibly leading to a less burdensome experience of the diet and increased compliance. Keywords: ketogenic diet, intractable epilepsy, infants, fine-tuning.