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Abstract: The 2-year-old child was diagnosed with epileptic encephalopathy not long after birth, but his condition was recurrent after regular treatment, and later inquiries revealed that poor daily dietary control could lead to recurrent seizures. In order to prevent the symptoms from seriously affecting the child’s brain development and leading to cognitive and motor dysfunction later, in addition to normal oral medication, the parents were instructed to pay attention to the standardized ketogenic diet for the child, which later reduced the number of seizures and basically controlled the child’s condition.
Basic information】Female, 2 years old
Type of disease】Epileptic encephalopathy
Hospital】Shandong Provincial Third Hospital
Time of consultation】November 2017
Treatment plan】Medication (topiramate tablets + sodium valproate extended-release tablets + clonazepam tablets) + ketogenic diet
Treatment period】Outpatient consultation, 1 month of telephone follow-up, followed by outpatient review every 3 months
Effectiveness】Stable condition and improvement of symptoms after adjustment of treatment plan
I. Initial interview
This is a special child who has had seizures since birth, is shorter and more unresponsive than other children of the same age, and cannot speak at the age of 2 years. The parents introduced that the child had spastic seizures since birth, and the diagnosis of epileptic encephalopathy had been made clearly through cranial MRI, EEG and genetic screening, and the cause of the child was related to genetic mutation. We wanted to see if there was a need to adjust the medication regimen or to see if there were other causes. A physical examination of the child revealed the presence of motor retardation. It was recommended to review the cranial MRI, EEG, and blood drug concentration tests.
Treatment
The diagnosis of the child’s condition is clear, and the outpatient EEG indicates that there are violent spikes and slow waves in the frontal lobe and central region. The patient’s family and the child’s life situation in detail, to understand the grandmother raised, so asked whether there is a diet control. Considering that the child’s diagnosis is clear, there is no contraindication to ketogenic diet, and the effect of drug control is not good, it is recommended to carry out ketogenic diet at the same time.
The ketogenic diet is a common diet in clinical practice, and parents are instructed to feed their children mainly with a low-carbohydrate, high-fat, moderate protein diet, and the ratio of fat, protein and carbohydrate in the ketogenic diet is recommended to be 4:1 or 3:1. The child was treated with topiramate tablets, sodium valproate extended-release tablets and clonazepam tablets, etc. One month later, the child’s symptoms were relieved and the number of spasmodic attacks was reduced.
III. Treatment effect
After excluding the contraindication of ketogenic diet, the child was put on ketogenic diet, the number of spasmodic seizures decreased, the symptoms of limb convulsions decreased, and the EEG indicated that the epileptic waves were less than before. 1 month later, the parents of the child indicated that the epileptic encephalopathy of the child was basically stable and well controlled, and no recurrence of the disease occurred. The child’s parents were instructed to bring the child to the neurology clinic every 3 months to monitor the child’s condition.
Notes
During the period of standardized drug treatment and ketogenic diet, we should also develop good living habits, keep regular meals, avoid eating puffed food and high-carbon snacks, pay attention to the child to avoid prolonged strenuous activities, avoid overexertion and staying up late, take the child to outdoor activities more often, and keep his mood relaxed. Once the child has a cold, fever and other infectious diseases, should actively seek medical advice to avoid aggravating the original disease.
V. Personal insight
The possibility of epileptic encephalopathy and genetic diseases and genetic mutations is high, so preconception genetic screening is necessary, and once the disease is diagnosed, it should be carried out in a specialized hospital to clarify the diagnosis and standardize treatment. At the same time, regular review, follow-up, standardized medication and reasonable dietary guidance should be carried out, as diet and care are very important in the treatment of this type of disease, and patients are advised to establish a long-term relationship with their doctor and to follow up regularly at the clinic. As in the case of this child, after the ketogenic diet and daily care, the disease is under control. Regular outpatient follow-up visits allow the family to understand the recovery status and the degree of control of the child’s disease, increasing confidence in the treatment.