1. Pediatric Neurology: Paul R. Carney, MD Zhao Liu, MD, PhD Edgard Andrade, MD Pediatric Gastroenterology (GI): Joel Andres, MD Christopher Jolley, MD Research Coordinators: Peggy R. Borum, PhD Lauren L. Jones, PhD

2. Overview of KT  Fasting was recognized as a way to control seizures.  Seizures would return once a normal diet was resumed.  In 1921 KT was born.  Although the therapy helps many children, we do not know how it works.

3. Ketogenic Therapy (KT)  High fat, low carbohydrate, adequate protein diet  Ketogenic Ratio = Fat : protein + carbohydrate  Forces the body to utilize fat (in the form of ketones) rather than carbohydrates as the main source of energy  Ketones are a byproduct of fatty acid metabolism

4. Ketogenic Therapy (KT)  Neurological treatment not a diet for weight control  Similar to your other therapies for seizures such as antiepileptic drugs (AEDs)  All changes that are made must be cleared by the research team and your clinical providers  For these reasons, we do not call it the Ketogenic Diet

5. Ketogenic Therapy (KT)  KetoBuddy  Support network  Improve your child’s care  Research the mechanism of KT  Weekly contact  Data collection  Create and make meals  Resource to assist you with all your child’s needs  We DO NOT change medications or provide any medical advice.

6. UF Ketogenic Therapy Research Program  KetoBuddy support system  More frequent monitoring of your child’s overall health  More labs  More measurements  Metabolic cart  Daily records  Monitor the progress and personalize your child’s therapy  Patient visits are at Shands in the GCRC  All research procedures are done free of charge  Inpatient visits at the GCRC are free of charge

7. Qualifications for Ketogenic Therapy  Typically (but not exclusively) used for children  If AEDs or other therapies are ineffective or produce undesirable side effects  If a surgical procedure is not an option  Intended for patients without fatty acid oxidation disorders

8. Before Initiation  Food Preferences Questionnaire  In order to help your child adjust into a state of ketosis easier, the weekend before: Limit simple sugars and starches Drink sugar-free or unsweetened liquids  Night before Initiation: Overnight fast for at least 8 hours Allowed to have water and medications

9. Initiation  Day 1-2 Start on a 1.5:1 ratio of fat : protein + carbohydrate Ratio increases by 0.5 every 1-2 meals  Day 3 Usually discharge between a 3:1 to 4:1 ratio

10. What to Bring to Initiation  Caregivers Guide  Foods/drink for Initiation that you and your KetoBuddy discussed  Daily home records of seizures  Multistix 10 SG  Food Scale  All medications and supplements in their original bottles  Videos, DVD player and DVDs, favorite toys, coloring books…something to keep your child occupied and feel more at home

11. What will be provided at Initiation  A mini fridge, microwave, and kitchen supplies  One caregiver will be provided with meals during their GCRC stay  Wireless internet access is available if you wish to bring your laptop

12. What to expect the first few weeks after Initiation  Adjustment period may include  Lethargy  Nausea/Vomiting  Hunger  Record keeping