Does the size of a ketogenic diet admission group influence outcomes?

Area of Science:

• Pediatric Neurology
• Dietary Therapies
• Epilepsy Management

Background:

• Pediatric centers commonly admit children for inpatient initiation of the ketogenic diet (KD) for epilepsy.
• Group admissions are sometimes used to optimize staff resources and foster family support networks.
• The impact of group admission size on ketogenic diet outcomes remains unclear.

Purpose of the Study:

• To investigate the association between the size of inpatient admission groups and outcomes during ketogenic diet initiation for pediatric epilepsy.
• To determine if group size influences the duration of the ketogenic diet or seizure reduction.

Main Methods:

• Retrospective chart review of 245 children with intractable epilepsy undergoing KD initiation at Johns Hopkins Hospital (2010-2020).
• Analysis of admission group sizes (1-5 children), 3-month seizure reduction, and total KD duration.
• Linear mixed effects modeling was employed to assess the relationship between group size and KD duration.

Main Results:

• Children admitted in groups of 3 showed significantly longer KD durations compared to those admitted alone (1.9 times longer, p=0.035).
• Larger admission groups (3-5 children) were associated with 1.6 times longer KD durations than smaller groups (1-2 children, p=0.036).
• No significant correlation was found between admission group size and 3-month seizure reduction.

Conclusions:

• Initiating the ketogenic diet in larger inpatient groups, particularly groups of 3, is associated with longer treatment durations in children with epilepsy.
• Potential factors contributing to longer adherence in larger groups may include enhanced peer and parent support.
• Group admission size does not appear to impact short-term seizure reduction efficacy.