Bridget Surtees - Epilepsy: Practical: The Ketogenic diet for Epilepsy

Presentation overview:

Bridget Surtees is a South African registered dietitian, with 2 decades of clinical experience at Great Ormond Street, University College London and Sydney Children’s Hospitals, as well as in her private practices Nutrition4Kids and Real Food Dietitians. She is co-author of Raising Superheroes along with Professor Tim Noakes and Jonno Proudfoot. Her areas of expertise include paediatric nutrition, eating disorders and nutritional therapy for people with features of the metabolic syndrome. In this lecture, Bridget Surtees presents a guide to the practical formulation and application of a ketogenic diet (KD) in the treatment of epilepsy in children and associated seizure management.

Learning objectives:

Understand the process of planning the KD diet including:

  • The selection criteria for choosing a specific KD version
  • The dietetic and anthropometric assessment
  • Education of carers
  • The basic steps to calculate the diet (Classical and MCT)
  • The meal plan construction
  • Understand the steps in initiating, monitoring and stopping the KD

Presentation summary:

In this practical lecture, Surtees guides us through assessing, constructing, implementing, monitoring and withdrawing a KD in paediatric refractory epilepsy. She discusses how to do a pre-assessment and assessment (anthropometric, dietary), including all the factors that need consideration. Surtees emphasises the importance of working with the family. She explains how to choose the best version of the KD depending on the child’s age and health. Surtees takes us through the steps to calculating the KD – calories, protein, fluids, and ketogenic ratios. She takes us through an example KD calculation, and how to apply that to the construction of a meal plan. She suggests online tools to help in constructing a keto meal plan. Surtees gives an example meal plan, with each meal maintaining the same ketogenic diet ratio. She emphasises the importance of precise calculations, strict adherence, paying attention to detail, double checking the acceptability of food prescription (adherence to ratio), and even parental weighing of food (classical & MCT diets).

Surtees gives supplementation recommendations, which always include a multivitamin and mineral, calcium, and vitamin D, and sometimes other supplements too – always be careful to exclude carbohydrate fillers. She emphasises the importance of parent / family education, and provides the core topics that must be covered in these education sessions. Surtees describes the KD initiation protocol, which is usually done in hospital and includes parental education and involvement in the implementation of the diet (with a scale). She lists the important parameters to be monitored in hospital as well as the aims for these and strategies to correct abnormal results. Surtees emphasises the importance of close ongoing monitoring and follow-up during the KD. She says that the duration a child stays on the KD (at least 3 months) depends on the outcomes and is a team decision, and finally, describes how to withdraw from the diet.

Downloadable resources:

  1. Presentation
  2. Reference list

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