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Epilepsy Case Study I
Amy Good
Priority Nutrition Care Distance Dietetic Intern: Community Rotation
January 2014
Contents
• Overview of client
• Description of epilepsy
– Prevalence
– Diagnosis
– Medical treatment
• Medical nutrition t...
Client Overview
• Female
• 4 years and 10 months old
• Past medical history of hydrocephalous
• Current medical history of...
What is epilepsy?
• Seizure disorder
• Seizure occurs when a rush of electrical impulses affects the
brain
• Epilepsy can ...
Prevalence of epilepsy
• <2 years old and >65 years old
• Male
• Racial minority
• 200,000 new cases of epilepsy each year
Medical diagnosis of epilepsy
• History of seizures
– Frequency
– Type
• Electroencephalograph (EEG)
Two main types of sei...
Medical treatment of epilepsy
• Antiepileptic drugs
– Some antiepileptic medications increase vitamin D metabolism in
the ...
Medical Nutrition Therapy: Ketogenic Diet
• Can be used for children with all types of seizures
• Last resort if medicatio...
Two types of ketogenic diet
• “Traditional” ketogenic diet
– Introduced in the 1920’s
– Diet begins with fasting to induce...
Two types of ketogenic diet
• MCT-based approach
– Diet begins with fasting to induce ketonuria
– Replaces long-chain fats...
Typical Ketogenic Diet Menu Using MCT Oil
Food Item Amount (g) Carbohydrates (g) Protein (g) Fat (g) Energy (kcal)
Breakfa...
Ketogenic diet
• Typically used for two years
• Caloric intake is the same as with any child
– Calculated by RD using age,...
Client Assessment and Energy/Nutrient Requirements
• 1200 kcal/day
• 3-5 ounces of protein
• 1-1.5 cups of fruit
• 1.5-2.5...
Current Client Medication and Nutrient Analysis
• Children’s
multivitamin
• Keppra (antiepileptic)
– Avoid consumption of
...
Nutrition Diagnosis, Intervention, Monitoring and Evaluation
• Diagnosis
– Food and nutrition related knowledge deficit re...
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Epilepsy case study presentation

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Dietetic case study on child with epilepsy

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Epilepsy case study presentation

  1. 1. Epilepsy Case Study I Amy Good Priority Nutrition Care Distance Dietetic Intern: Community Rotation January 2014
  2. 2. Contents • Overview of client • Description of epilepsy – Prevalence – Diagnosis – Medical treatment • Medical nutrition therapy for epilepsy • Nutritional assessment of client – Nutrition diagnosis – Nutrition intervention – Monitoring and evaluation
  3. 3. Client Overview • Female • 4 years and 10 months old • Past medical history of hydrocephalous • Current medical history of epilepsy – Being treated with Keppra
  4. 4. What is epilepsy? • Seizure disorder • Seizure occurs when a rush of electrical impulses affects the brain • Epilepsy can be categorized as: – Symptomatic – linked to a specific disease or abnormality or – Cryptogenic – not linked to a specific disease
  5. 5. Prevalence of epilepsy • <2 years old and >65 years old • Male • Racial minority • 200,000 new cases of epilepsy each year
  6. 6. Medical diagnosis of epilepsy • History of seizures – Frequency – Type • Electroencephalograph (EEG) Two main types of seizures Description Tonic-clonic (grand mal) seizure Lasts 1-2 minutes, groggy/disoriented for minutes to hours after regaining consciousness, postictal phase is characterized by sleep, headache, confusion, soreness Absence (petit mal) seizure May appear to be daydreaming, lasts only a few seconds, no postictal fatigue/disorientation, no loss of consciousness
  7. 7. Medical treatment of epilepsy • Antiepileptic drugs – Some antiepileptic medications increase vitamin D metabolism in the liver • Inhibits the absorption of calcium in the intestines. Long term use of these medications may result in osteomalacia or rickets. – Side effects range from anorexia to upset stomach to suicidal tendencies • Important for doctors to be involved and have regular follow ups when clients are taking antiepileptic drugs
  8. 8. Medical Nutrition Therapy: Ketogenic Diet • Can be used for children with all types of seizures • Last resort if medication is not working • 1/3 of children following the ketogenic diet became seizure free • The diet initiates ketosis – Ketones in the blood are elevated – Ketones are formed when glycogen stores have run out • Not yet understood how diet decreases seizure occurrence
  9. 9. Two types of ketogenic diet • “Traditional” ketogenic diet – Introduced in the 1920’s – Diet begins with fasting to induce ketonuria – 4:1 ratio of fats to protein/CHO – Fats should make up typically 75% of calories – Fluids are restricted to no more than 2L/day – Foods such as bread and pasta are not allowed – Vitamin and mineral supplementation is encouraged to provide full nutrition “Traditional” Ketogenic Diet Breakdown Sample meal plan for 2,000 calorie diet Meal Fat (g) Protein (g) Carbohydrates (g) Calories (kcal) Breakfast 40 20 0 440 Lunch 55 35 4 651 Dinner 60 50 4 756 Snack 15 5 0 155 Total 170 110 8 2002
  10. 10. Two types of ketogenic diet • MCT-based approach – Diet begins with fasting to induce ketonuria – Replaces long-chain fats with medium-chain triglycerides (MCT) – Ketosis can be more easily achieved with MCT so nonketogenic foods are allowed (carbohydrates) – Fluid is not restricted
  11. 11. Typical Ketogenic Diet Menu Using MCT Oil Food Item Amount (g) Carbohydrates (g) Protein (g) Fat (g) Energy (kcal) Breakfast White bread 5 2.8 0.4 0.2 13 Eggs, scrambled 48 6.1 5.5 74 Cream, heavy whipping 10 0.3 0.3 3.8 36 Margarine or butter 5 5.0 45 MCT oil 12 12.0 108 Fat 11 11.0 99 Drink sweetened w/ nonnutritive sweetner 240 Total 2.8 6.8 37.5 375 Lunch American cheese 12 2.2 2.8 3.6 52 Ham 23 0.7 3.7 3.9 53 MCT oil mayonnaise 11 11.0 99 Fat 19 19.0 171 Drink sweetened w/ nonnutritive sweetener 240 Total 2.9 6.5 37.5 375 Dinner Turkey 19 6.3 0.7 32 Tomato 10 0.5 0.1 0.0 3 Green beans 10 0.6 0.2 0.0 3 Potatoes 12 1.4 0.2 0.0 8 Margarine 15 15.0 135 MCT oil mayonnaise 11 11.0 99 Fat 10 10.0 90 Drink sweetened w/ nonnutritive sweetener 240 Total 2.8 6.8 36.7 370 Daily Total 8.5 20.1 111.7 1120 MCT, Medium-Chain Triglyceride Adapted from Krause’s Food and Nutrition Therapy 12th Edition.
  12. 12. Ketogenic diet • Typically used for two years • Caloric intake is the same as with any child – Calculated by RD using age, gender, weight, height, and activity level • Requires a lot of counseling – New foods – Compliance with diet • Implications – Growth problems – Nutrient deficiencies
  13. 13. Client Assessment and Energy/Nutrient Requirements • 1200 kcal/day • 3-5 ounces of protein • 1-1.5 cups of fruit • 1.5-2.5 cups of vegetables • 4-6 ounces of grains • 2.5-3 cups of dairy Lab Value Age 4 years 10 months old Height 46” Weight 55# BMI 18.3 (normal) Hgb 13.5g/dl
  14. 14. Current Client Medication and Nutrient Analysis • Children’s multivitamin • Keppra (antiepileptic) – Avoid consumption of raw ginkgo seeds as it can decrease effectiveness of drug Meal Amount Carbohydr ates (g) Fat (g) Protein (g) Calories (kcal) Breakfast Frosted Flakes 30g 27 0 1 110 2% milk 1 cup 11.4 4.8 8.1 122 Lunch Peanut butter and jelly sandwich on white bread 1 sandwich 47 19 12 400 2% milk 1 cup 11.4 4.8 8.1 122 Dinner Macaroni and cheese 1 cup 48 3 1 260 2 % milk 1 cup 11.4 4.8 8.1 122 Snack Grape juice 1 cup 38 0 1 140 Total 194.2 36.4 39.3 1,276 Percentage of daily calories 61% 26% 13%
  15. 15. Nutrition Diagnosis, Intervention, Monitoring and Evaluation • Diagnosis – Food and nutrition related knowledge deficit related to the use of a training cup as evidenced by training cup use after two years of age • Intervention – Will offer a regular cup daily as opposed to a training cup to decrease chance of dental carries – Will offer 2 servings of quality protein daily, such as chicken, eggs, or beans – Will try to replace one carbohydrate serving at dinner with a fat or protein serving, daily • Monitoring and evaluation – Follow up appointment to re-evaluate goals – Referral to physician if necessary

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