Classic ketogenic diet for epilepsy

The treatment is relevant for children with epilepsy where the disease is difficult to treat with medication. The ketogenic diet consists of meals with lots of fat and very few carbohydrates, and is an imitation of the body's reaction to fasting. The treatment can reduce seizures and have a positive impact on concentration, attention, sleep, mood, and behavior. We don't know for sure what the effect is due to, but it is probably related to the change in metabolism (metabolism).

Epilepsy

All meals in the diet have the same ratio of grams of fat to the sum of grams of protein and carbohydrates. This ratio is called the ketogenic ratio. During treatment, blood sugar decreases and the body switches to fat burning. When fat is burned, the liver produces ketone bodies (ketones). We say that you enter ketosis. The brain can use the ketone bodies as an energy source.

Referral and assessment

Children and young people with epilepsy who do not achieve seizure control with medication can be referred to specialist healthcare services for assessment of treatment with a ketogenic diet.

The Specialist Hospital for Epilepsy (SSE) has a national function for treatment with a ketogenic diet. Here there are diet teams consisting of a doctor, nurse(s), and clinical nutritionist with knowledge and experience with the ketogenic diet. Other professional groups are involved as needed.

Referrals to SSE should be sent via the referral reception at Oslo University Hospital

Knowledge-based guideline

A knowledge-based guideline has been developed on epilepsy, and treatment with ketogenic diet is also described here.

See the knowledge-based guideline on epilepsy at epilepsibehandling.no

Referral criteria for the Specialist Hospital for Epilepsy

Before

4–8 weeks before the start of the diet, children and parents come to the Specialist Hospital for Epilepsy (SSE) for a consultation.

Seizure registration

The child's seizures should be recorded for at least one month before the start of the diet. This will provide a basis for assessing the effect of the diet on the seizures. Fewer seizures, shorter seizures, and weaker seizures are important changes.
Use a seizure calendar and register seizure types, frequency, and duration. Also note changes in the child's well-being and comfort.
In children with very many seizures, it may be too extensiveto count all seizures. Then it can be solved this way:

Many seizure types: Only register the seizure types that have the greatest consequences for the child. These are the seizures we primarily try to reduce.
Frequent seizures: For example, choose one hour each day when the child tends to have many seizures and register all seizures. Register at the same time each day.

During

Training and start of diet

The child is initially admitted for a two-week training stay at SSE, and we recommend that both parents are present during the first week. Towards the end of the stay, the department offers training for the child's closest relatives. Starting the diet requires close collaboration between parents, clinical nutritionist, nurse, and doctor. At the start, parents receive written material about implementing the diet.

The principles of the diet

Before starting the diet treatment, the child's energy needs are calculated and the diet is planned based on normal needs. To achieve stable ketosis, the diet must be followed closely. The diet usually consists of four to five equally sized meals. Fluid needs are calculated based on body weight. Both food and fluids are distributed evenly throughout the day, and everything that is measured out must be eaten and drunk. Regularity and accuracy are important to achieve effect.

The meals

The diet is calculated by a clinical nutritionist, who puts together an ingredient list. Various dishes can be made from the list. The child can eat the food raw, cooked, fried, and seasoned, but it is important that everything on the list comes with it. Ingredients are weighed on a digital scale with

1 gram accuracy. You will receive training in cooking from nurses on the ward.

Tube feeding

The ketogenic diet can also be given as tube feeding. It is a nutritionally complete product that is available as a ready-mixed solution or powder to be mixed with water. Sometimes other products are added to achieve the correct ratio of fat, carbohydrate, and protein. Ketocal can be used alone or in combination with regular food.

Fine-tuning the diet

During the time the child is on the diet, adjustments in calorie intake, ketogenic ratio, and carbohydrate amount may sometimes need to be made to see what gives the best reduction in seizures.

To be able to assess whether the diet is effective, we recommend that it be tried for at least three months. An individual assessment is made of how long treatment with the diet is needed.

Show more

Follow-up at home

This treatment requires close follow-up by the parents at home:
Urine dipstick (Multistix) monthly to rule out blood in the urine
Measurement of ketosis in blood and/or urine according to agreement with the treating physician
Record seizures and information about the child's general condition. Important observations are appetite, nausea, constipation, sleep patterns, attention, and any infections.
Weigh the child's body weight once a week before breakfast for the first three months. Then once a month.

Dietary record

Check-ups at the Specialist Hospital for Epilepsy, SSE
The first check-up is 4 weeks after discharge. Then 3 months after the start and every 3 months thereafter for the first year. In addition to conversations with a nurse, clinical nutritionist, and doctor, blood tests and urine tests are taken, and weight and height are recorded.

EEG recording is performed after 6 and 12 months on the diet.

Tapering of epilepsy medications is assessed individually.

Be aware

Discomfort from high ketosis or low blood sugar can occur, especially in the initial phase, but also later. The symptoms of low blood sugar and high blood ketosis can be relatively similar.

The measures in both cases consist of adding quick carbohydrates that will increase blood sugar and lower blood ketosis.

Symptoms of low blood sugar and/or high blood ketosis
fatigue
paleness
irritability
nausea
loss of appetite
tremors

rapid breathing

30 ml of apple or orange juice is given in cases of:
blood sugar below 3 mmol/L and symptoms
blood sugar

5 mmol/L or lower

high blood ketosis and symptoms

Note that if the child has no discomfort from high ketosis, it should not be treated unless the blood ketosis exceeds 7-8 mmol/L.

Check blood sugar and ketosis, and repeat the procedure if necessary.

If these measures have been carried out without improvement or if the child has a decreased level of consciousness, a doctor must be contacted.
Side effects
weight loss
low blood sugar
nausea
fatigue
vomiting
ketoacidosis (too high acidity in the blood)
constipation
worsening of reflux (heartburn)
elevated fat content in the blood
reduced growth
menstrual disorders
seizure increase

osteoporosis

kidney stones

Pancreatitis is a very rare side effect.

Worsening of the seizure situation

Sørlandet Hospital Arendal

Department of Paediatrics and Adolescent Medicine (BUA), Arendal
Contact the Department of Paediatrics and Adolescent Medicine (BUA), Arendal

Meeting place

Contact the outpatient clinic of the children's department 6E on the 6th floor of the main building

Sørlandet Hospital Arendal

Sykehusveien 1

Sykehusveien 1, 4838 Arendal

TransportPublic transport

akt.no

Patient travelYou may be entitled to have the necessary expenses covered when traveling to and from the treatment location..
You should initially use public transport, and you must pay a deductible. To get money back for the trip, you must fill out a travel expense form and send it to

Practical information
Pharmacy
In the hospital pharmacy in Arendal, you can hand in prescriptions and buy pharmacy goods.

You will find us on the 1st floor of the main building, just inside the entrance.

30-
Hospital pharmacy Arendal Cancel/change appointment

You can also contact the department where you have an appointment or call the switchboard on telephone:

38 07 30 00

Children and young people are affected when someone in the family is ill and needs to understand what is happening. It may be that you yourself are a patient, a relative, or that you are a parent of sick children with siblings. We at the hospital will contribute to ensuring that children and young people in your family are well cared for.

Children as relatives

Visiting hours

Visiting hours may vary at the various departments and locations. Please check with the department you have an appointment with for more information.
See overview of the hospital's departments
General visiting hours:

Arendal:
00-
00 on weekdays

00-
00 and
00-

00 on weekends and holidays

00-

00-

00
00-

00 (siesta/no visits:
00-
00)
Kristiansand:
00- 00 on weekdays.
00-
00 and
00 on weekends and holidays
Delivery ward:
00–

00 every day for the newborn's healthy siblings.

The patient library in Arendal is located in the basement of the main building. It is self-service and open 24 hours a day. Here you can borrow books and read newspapers and magazines.
Flowers and perfume

Many people want to give a floral greeting when visiting a patient at the hospital, but due to allergies and infection hazards, several of our departments are flower-free. We appreciate it if you who want to bring a gift choose something other than flowers.

Some patients also react allergically to perfume or creams with perfume. We ask that this be taken into consideration.

Photography, filming and sound recording
Many patients and relatives want to take pictures/videos or blog from their time at the hospital. Of course, you are welcome to do so, as long as you respect the privacy of others.
Here are a couple of good tips for using social media for you as a patient or relative:

Parents/guardians decide whether you can take pictures of children or publish pictures of their children online. Parents should take into account what is best for the child. When the child is 12 years old, great weight should be placed on what the child thinks. When the child is 15 years old, they decide for themselves whether it is okay to be photographed and whether it may be published.

Remember that employees must also give their permission if you want to publish pictures you have taken of them.

You should remove content you have published if the person involved asks you to. If you are not heard, you can contact:

www.slettmeg.no

Sound recording

It is not illegal to record conversations you yourself participate in for private use. Publishing and sharing, however, requires the consent of the person you are talking to. Secret recordings of conversations you do not participate in are illegal.

Chapel/quiet room
From time to time, we need a room for rest and reflection. We have three such rooms available for you and your relatives. The rooms are open to all regardless of beliefs and faith.In Arendal, you will find the hospital's quiet room/chapel in the basement of the main building. In Kristiansand, the room is located on the first floor of the main building, north entrance. Both rooms are open 24 hours a day. In Flekkefjord, the chapel is located near the parking lot to the left of the main entrance.There is also the possibility of holding a memorial service in the chapel in the event of a death. This is arranged by contacting the hospital priests.
Eg Church in Kristiansand is open every weekday between 08-18, for those who want a room for silence and reflection. Open from 10-18 on weekends.

Kiosk
Kiosk
The kiosk is located in the vestibule on the 1st floor.

Here you can buy kiosk goods such as newspapers, magazines, fruit, chocolate, biscuits, ice cream, soft drinks, cards, flowers, simple toiletries and various gift items.
In addition, you can buy buns, chicken wraps, rolls, salads, calzones, panini and sausages.
Opening hours:

Monday-Friday:

00-

00Saturday and Sunday:

00-00

Parking
The parking spaces at Sørlandet Hospital are subject to a fee from Monday to Friday from

00-
All who wish to park on the hospital's premises must follow the signs and instructions on the payment machines.

At the hospital in Kristiansand, you can register your parking via the Easypark app, via the machine where you park, or the Flowbird website.

Register payment on the website
Overview of parking spaces at Eg in Kristiansand
At the hospital in Arendal, cameras read the registration number of vehicles entering and exiting the parking garage through the Autopay service. Follow the signs and read the instructions.

If you have not created a profile on

Autopay.io

, you can pay in the machine at the main entrance. Enter the vehicle's registration number. You can pay with card or cash, but the machine does not give change.

Register as a customer with registration number and bank card at www.autopay.io. When you have registered, you will automatically pay each time you park in the parking garage.In some periods, e.g. during heavy snowfall, it can be difficult to find a parking space. We therefore recommend being out in good time.
For electric cars:Arendal: Electric cars can park for free in areas marked with a maximum of 1, 2 or 3 hours. On other areas, a fee must be paid from the first hour.

Flekk
.

Classic ketogenic diet for epilepsy

Referral and assessment

Knowledge-based guideline

Referral routines for healthcare professionals

Before

Before Show more

Seizure registration

During

During Show more

Training and start of diet

The principles of the diet

The meals

1 gram accuracy. You will receive training in cooking from nurses on the ward.

To be able to assess whether the diet is effective, we recommend that it be tried for at least three months. An individual assessment is made of how long treatment with the diet is needed.

After After

Show more

Dietary record

Tapering of epilepsy medications is assessed individually.

The measures in both cases consist of adding quick carbohydrates that will increase blood sugar and lower blood ketosis.

rapid breathing

Check blood sugar and ketosis, and repeat the procedure if necessary.

kidney stones

Worsening of the seizure situation

If there is a good effect of the diet, an increase in seizure frequency can be due to the intake of incorrect food and too low ketosis. Infections, too long time between meals and too high calorie intake are other possible causes. Contact

Department of Paediatrics and Adolescent Medicine (BUA), Arendal

Meeting place

Sykehusveien 1, 4838 Arendal

Find your way

You can reach our locations by public transport. Go to Agder kollektivtrafikk to find your route:

You should initially use public transport, and you must pay a deductible. To get money back for the trip, you must fill out a travel expense form and send it to

Patient travel

Open every weekday from

Does the appointment not suit you? Now you can, as someone who receives the letter of invitation digitally on helsenorge.no, send a direct message to the department you are going to if you need a new time for the appointment. You must be a registered user on helsenorge to access the service.

Children and young people in the family?

Flekkefjord:

00 and

Delivery ward:

00-

Library

Take into account others. You must have consent if you want to take pictures or videos of patients or employees. All patients have the right to privacy when they are at the hospital.

Chapel/quiet room

Eg Church in Kristiansand is open every weekday between 08-18, for those who want a room for silence and reflection. Open from 10-18 on weekends.

The kiosk is located in the vestibule on the 1st floor.

At the hospitals in Arendal and Kristiansand, it is possible to pay for parking with EasyPark (mobile solution), card or coin on other places. See signs for both payment options and time limits.

Pay in the payment machine

Pay automatically

Kristiansand: Electric cars pay a fee from and including the first hour.