1. Epilepsy Case Study I Amy Good
Priority Nutrition Care Distance Dietetic Intern: Community Rotation
January 2014

2. Contents Overview of client Description of epilepsy
Prevalence
Diagnosis
Medical treatment
Medical nutrition therapy for epilepsy
Nutritional assessment of client
Nutrition diagnosis
Nutrition intervention
Monitoring and evaluation

3. Client Overview Female 4 years and 10 months old
Past medical history of hydrocephalous
Current medical history of epilepsy
Being treated with Keppra

4. What is epilepsy? Seizure disorder
Seizure occurs when a rush of electrical impulses affects the brain
Epilepsy can be categorized as:
Symptomatic – linked to a specific disease or abnormality or
Cryptogenic – not linked to a specific disease

5. Prevalence of epilepsy
<2 years old and >65 years old
Male
Racial minority
200,000 new cases of epilepsy each year

6. Medical diagnosis of epilepsy
History of seizures
Frequency
Type
Electroencephalograph (EEG)
Two main types of seizures
Description
Tonic-clonic (grand mal) seizure
Lasts 1-2 minutes, groggy/disoriented for minutes to hours after regaining consciousness, postictal phase is characterized by sleep, headache, confusion, soreness
Absence (petit mal) seizure
May appear to be daydreaming, lasts only a few seconds, no postictal fatigue/disorientation, no loss of consciousness

7. Medical treatment of epilepsy
Antiepileptic drugs
Some antiepileptic medications increase vitamin D metabolism in the liver
Inhibits the absorption of calcium in the intestines. Long term use of these medications may result in osteomalacia or rickets.
Side effects range from anorexia to upset stomach to suicidal tendencies
Important for doctors to be involved and have regular follow ups when clients are taking antiepileptic drugs

8. Medical Nutrition Therapy: Ketogenic Diet
Can be used for children with all types of seizures
Last resort if medication is not working
1/3 of children following the ketogenic diet became seizure free
The diet initiates ketosis
Ketones in the blood are elevated
Ketones are formed when glycogen stores have run out
Not yet understood how diet decreases seizure occurrence

9. Two types of ketogenic diet
“Traditional” ketogenic diet
Introduced in the 1920’s
Diet begins with fasting to induce ketonuria
4:1 ratio of fats to protein/CHO
Fats should make up typically 75% of calories
Fluids are restricted to no more than 2L/day
Foods such as bread and pasta are not allowed
Vitamin and mineral supplementation is encouraged to provide full nutrition
“Traditional” Ketogenic Diet Breakdown
Sample meal plan for 2,000 calorie diet
Meal
Fat (g)
Protein (g)
Carbohydrates (g)
Calories (kcal)
Breakfast 40 20
440
Lunch 55 35 4
651
Dinner 60 50
756
Snack 15 5
155
Total
170
110 8
2002

10. Two types of ketogenic diet
MCT-based approach
Diet begins with fasting to induce ketonuria
Replaces long-chain fats with medium-chain triglycerides (MCT)
Ketosis can be more easily achieved with MCT so nonketogenic foods are allowed (carbohydrates)
Fluid is not restricted

11. Typical Ketogenic Diet Menu Using MCT Oil
Food Item
Amount (g)
Carbohydrates (g)
Protein (g)
Fat (g)
Energy (kcal)
Breakfast
White bread 5
2.8
0.4
0.2 13
Eggs, scrambled 48
6.1
5.5 74
Cream, heavy whipping 10
0.3
3.8 36
Margarine or butter
5.0 45
MCT oil 12
12.0
108
Fat 11
11.0 99
Drink sweetened w/ nonnutritive sweetner
240
Total
6.8
37.5
375
Lunch
American cheese
2.2
3.6 52
Ham 23
0.7
3.7
3.9 53
MCT oil mayonnaise 19
19.0
171
Drink sweetened w/ nonnutritive sweetener
2.9
6.5
Dinner
Turkey
6.3 32
Tomato
0.5
0.1
0.0 3
Green beans
0.6
Potatoes
1.4 8
Margarine 15
15.0
135
10.0 90
36.7
370
Daily Total
8.5
20.1
111.7
1120
MCT, Medium-Chain Triglyceride
Adapted from Krause’s Food and Nutrition Therapy 12th Edition.

12. Ketogenic diet Typically used for two years
Caloric intake is the same as with any child
Calculated by RD using age, gender, weight, height, and activity level
Requires a lot of counseling
New foods
Compliance with diet
Implications
Growth problems
Nutrient deficiencies

13. Client Assessment and Energy/Nutrient Requirements
1200 kcal/day
3-5 ounces of protein
1-1.5 cups of fruit
cups of vegetables
4-6 ounces of grains
2.5-3 cups of dairy
Lab
Value
Age
4 years 10 months old
Height
46”
Weight
55#
BMI
18.3 (normal)
Hgb
13.5g/dl

14. Current Client Medication and Nutrient Analysis
Meal
Amount
Carbohydrates (g)
Fat (g)
Protein (g)
Calories (kcal)
Breakfast
Frosted Flakes
30g 27 1
110
2% milk
1 cup
11.4
4.8
8.1
122
Lunch
Peanut butter and jelly sandwich on white bread
1 sandwich 47 19 12
400
Dinner
Macaroni and cheese 48 3
260
2 % milk
Snack
Grape juice 38
140
Total
194.2
36.4
39.3
1,276
Percentage of daily calories
61%
26%
13%
Children’s multivitamin
Keppra (antiepileptic)
Avoid consumption of raw ginkgo seeds as it can decrease effectiveness of drug

15. Nutrition Diagnosis, Intervention, Monitoring and Evaluation
Food and nutrition related knowledge deficit related to the use of a training cup as evidenced by training cup use after two years of age
Intervention
Will offer a regular cup daily as opposed to a training cup to decrease chance of dental carries
Will offer 2 servings of quality protein daily, such as chicken, eggs, or beans
Will try to replace one carbohydrate serving at dinner with a fat or protein serving, daily
Monitoring and evaluation
Follow up appointment to re-evaluate goals
Referral to physician if necessary