Ketogenic diet therapy provision in the COVID-19 pandemic: Dual-center experience and recommendations

Abstract

The current coronavirus-19 pandemic has changed dramatically how neurologists care for children and adults with epilepsy. Stay-at-home orders and resistance to hospitalizations by patients have led epileptologists to engage in telemedicine and reevaluate how to provide elective services. Ketogenic diet therapy is often started in the hospital, with families educated in hospital-based classes, but this is difficult to do in this current pandemic. At our two academic centers, both our pediatric and adult epilepsy diet centers have had to quickly consider alternative methods to both start and maintain ketogenic diet therapy. This paper provides several examples of how ketogenic diet therapy can be provided to patients in unique ways, along with recommendations from other experts and patients, learned over the past few months.

Comment on: Ketogenic diet therapy provision in the COVID-19 pandemic: Dual-center experience and recommendations

“…We definitely agree with Kossoff et al [ 1 ] that maintenance of patients on KDTs is also possible during a pandemic period, and we suggest to offer to patients and their families the opportunity to perform a follow-up visit in teleassistance to provide clinical and treatment monitoring and to alleviate possible concerns as a bridge to the normal face-to-face clinic follow-up, which should remain the preferable practice when feasible.…”

“…We appreciated Kossoff et al's recent paper [ 1 ] on ketogenic diet therapy provision in the COVID-19 pandemic as also in our experience, a substantial modification of the neurological and nutritional assistance of patients with epilepsy undergoing ketogenic diet therapies (KDTs) became necessary. Our hospitalization and care center is located in Lombardy, the Italian region most affected by the COVID-19 pandemic, and our center is one of the national reference centers for the treatment of epilepsy with KDTs.…”

Telemedicine, drug-resistant epilepsy, and ketogenic dietary therapies: A patient survey of a pediatric remote-care program during the COVID-19 pandemic

“…In this study, online platforms (e.g., Zoom, Polycom, or Doximity) and phone calls and e-mail were used to contact the families and patients. Recommendations are given on how to manage KDTs during the pandemic [ 22 ]. Ferraris et al retrospectively described the use of remote monitoring of the classic KD by e-mail in 34 children with DRE or glucose transporter type 1 deficiency syndrome during the first year of follow-up [ 32 ].…”

“…Ketogenic diet therapy (KDT) is the most common nonpharmacologic treatment for people with drug-resistant epilepsy (DRE). At present, there are four major KDTs: the classic KD, the modified Atkins diet (MAD), the medium-chain triglyceride diet (MCT), and the low glycemic index treatment (LGIT) [ [20] , [21] , [22] , [23] , [24] , [25] , [26] ]. There are few reports on the management of KDTs for patients with epilepsy through telemedicine as the main resource [ 27 ].…”

Examining the impacts of the COVID-19 pandemic on the well-being and virtual care of patients with epilepsy

“…Another study examined the risk of contracting COVID-19 among those with epilepsy, highlighting that pre-existing comorbidities could put persons with epilepsy at risk, but did not include perspectives on the situation from patients themselves [16]. Another study did conduct telemedicine visits with the aim of elucidating the impact of ketogenic diet therapy [17], but did not collect in-depth information regarding quality of life. Our study complements prior work by directly interviewing persons living with epilepsy to extract themes on coping with social distancing and remote healthcare imposed by the public health response to the COVID-19 pandemic.…”