Ketogenic diet: an alternative treatment for refractory epilepsy in children.

RATIONALE: The aim of this study was to establish the first ketogenic diet treatment program for refractory epilepsy in Thailand and to assess its feasibility as well as its efficacy. METHOD: Children with refractory epilepsy were enrolled in the study. This was a prospective open trial study with 35 children (16 boys and 19 girls). Not all patients started on the diet at the same time. Each patient was cumulatively enrolled in this study over the period of 4 years. The mean age on diet was 5.37 +/- 3.57 years (2 months-13 years), mean age of onset of seizures was 19.2 +/- 27.47 months (1 days-8 years), and an average duration on ketogenic diet was 7.67 months (6 days to 29 months). The classic "4:1" formula ketogenic diet was used with some modification. The patient's parents were allowed to improvise and use any fatty diets available in the market such as coconut milk if needed. Parents were closely supervised and instructed on how to prepare the patient's own meals while in the hospital and continued to attend neurology and nutrition clinics. The seizure outcome and side effects were monitored as well as a daily test for urine ketone. RESULTS: At 1 month, 3 months, 6 months, and 12 months duration on the diet, 90 per cent seizure reductions were achieved in 62.5 per cent, 68.18 per cent, 75 per cent, and 66.67 per cent of patients remaining on the diet, respectively. The number of antiepileptic drugs (AEDs) used by each patient also decreased as a result of better seizure control. CONCLUSION: Ketogenic diet can be tried as a management option for refractory epilepsy. It is not difficult to implement even in a developing country like Thailand where resources are limited. It may also help reduce the cost of treatment especially in view of the high prices of the new AEDs.

A rice starch added follow-on formula for infants with sleeping difficulty.

A total of 15 infants aged between 4-12 months with sleeping difficulty were enrolled in the study. All participants were given a test follow-on formula (cow's milk based), with added rice starch. The test formula was advised to be given at night-time for a 7-day period. Sleeping patterns were recorded 2 days prior to the study and during the 7-day study period. It was shown than 11 out of 15 cases (73.3%) had satisfactory results. Two cases (13.3%) were withdrawn from the study by their parents due to vomiting after taking the formula. We found that both cases developed concomitant respiratory tract infection one day after starting the study, and 2 cases (13.3%) were lost to follow-up. In conclusion, the majority of cases showed satisfactory results in terms of night sleeping pattern after switching to the rice starch added follow--on formula.

Adolescent height: relationship to exercise, milk intake and parents' height.

The investigators studied the height of adolescents in the age range of 12 to 18 years from 2 schools in Bangkok. Questionnaires asking their rates of organised exercise per week, of milk intake per day and their parental heights were given to a total of 545 male and 615 female students. The completed questionnaires were analyzed. We could categorize these subjects into 3 groups according to their heights which were Group I (height > 97th%-ile), Group II (height between 50-97th%-ile) and Group III (height < 50th%-ile). Those in Group I had parents, whose height was significantly greater than those of the other groups. There was no difference in organized exercise among the 3 groups. Milk intake of female adolescents from Group I was significantly more than the other groups. It is concluded that parents' height in both males and females and milk intake in females contribute to a greater adolescent height.

Childhood malnutrition: an analysis of the effects of nutritional advice.

An analysis of malnutrition was done in 65 infants and preschool children (18 boys and 47 girls) who were under the third percentile of weight for age. Fifty-seven percent of cases has hematocrits of less than 36%, 7% had hematocrits of less than 30% and two had iron deficiency anemia which improved after iron supplement. Eosinophils of more than 400 cells/mm3 were found in 35% of cases. Eleven percent had eosinophils of more than 1,000 cells/mm3. Parasites were found on stool examination in 12.5% of cases. Bone development was retarded in 39% of 23 cases. In 7 cases with bone development delayed more than 6 months, thyroid function and trace elements were analysed and found to be within normal limits. In 5 cases with delayed bone development and height less than 5 cm/year, growth hormones showed normal levels. Proper nutritional advice resulted in improvement in body weight and height in 57% of cases, tricept skin fold in 73%, bicept skin fold in 60%, arm muscle area in 50% and arm fat area in 29% of cases. Improvement was not associated with family income or education of the people who cared for the patients.

A summer camp for childhood obesity in Thailand.

The results of a 4-week summer camp for childhood obesity were reported. Twenty-one children with moderate to severe obesity, aged between 8-13 years, joined the program. Dietary restriction during the official hours and dietary self-control at home were implemented throughout the program. Exercise, swimming and group therapy were also implemented throughout the program. Weekly sight-seeing outside the camp was very interesting for the participants. After the program, all participants had lost weight which was about 5 per cent of their initial weight. Most of the weight loss was due to loss of body fat but not lean body mass. No complications occurred during the program. The 4-week summer camp is then practical for initiating weight loss for obese children. Long-term follow-up which is underway will be reported later.

Compartmental change after weight reduction in childhood obesity.

Ten obese children aged 8-13 years participated in a 4-week program of weight reduction. Dietary restriction of 800 kcal/day and mild exercise were the two features of the program. With this regimen the investigators expected that their lean body mass would be preserved while body fat would decrease. After the 4-week program, we found that those who were mildly and moderately obese lost more than 5 per cent of their body fat but less than 1 per cent of lean body mass. Those children with morbid obesity lost more than 5 per cent of body fat and lean body mass. It is concluded that the regimen is suitable for mild and moderate obesity, but for morbid obesity, a new regimen with higher energy and higher protein in the diet may be more suitable than the current one.

Diabetic education, special consideration of Oriental patients.

The important of patient education program in the management of diabetes has been widely recognized. We studied to find out in general what the patients and their parents know about diabetes and their self-care by using a questionnaire. Then, the diabetic education was given by one-to-one basis to every patient. Thirty four insulin-dependent diabetes mellitus attended the diabetic the clinic at Siriraj Hospital, Bangkok age ranged from 4 to 22 years with peak age at 11 to 15 years. Male to female ratio was l:i. Majority came from low socioeconomic families. 23.5 percent were from separated families, one patient lived with neither her mother nor father. Only one patient had home glucose monitoring. Fourteen cases (41.2%) had been hospitalized with diabetic ketoacidosis (DKA) over the past year, however, there was no statistically significant difference between admission with DKA and low socioeconomic status. In addition to insulin, there were 8 patients taking herbs to cure diabetes. Only 6 patients were able to follow their meal plan and only one case ever used the food exchange list. Most patients accepted being diabetic and attended the clinic regularly mainly to get financial supports. The situation in our country is different from that in the western countries as the patients are low in literacy and socioeconomic status. A well-planned educational programme is essential to cater to the need to the oriental patients.

Childhood malnutrition: Nutritional and social background analysis.

The analysis was done in 52 infants and Preschool children under 6 years of age who were referred to Pediatric nutrition clinic, Siriraj Hospital during September 1987 to August 1988 because of growth delay. AII of the patients, 18 boys and 34 girls were under 3rd percentile of body weight. 52% of the cases were 12.23 months old, while average age was 30 months. The onset of growth delay was noticed at the average age of 8.8 months. In 62% of the cases the onset was associated with breast milk weaning, while in 16% and 22% they were associated with additional food and illness (diarrhea, vomiting and measles) respectively. Eighty three percent of the cases was classified by modified Gomez’s criteria as having first degree malnutrition. While 17% was second degree. 29% was classified to be acute malnutrition. While another 29% was nutritional dwarfism and 40% was acute on chronic malnutrition by Waterloo’s classification. 71% and 96% of the cases were less than 10 percentiles of arm muscle area and arm fat area respectively. The three-day caloric count was completely performed in 20 patients. The caloric intake was found to be significantly lower than expected calories per both ideal body weight and recent weight. The average percentage of protein: fat: carbohydrate was 15: 30: 55.The amount of food and the way of feeding seemed to be more important to childhood malnutrition than the familial income.