Table 1 Recommendations of evaluation before KD
From: Ketogenic dietary therapy in adult status epilepticus: current progress and clinical application
Evaluation | Baseline (pre-therapy) | Follow-up |
|---|---|---|
Nutrition/monitoring | ||
Mandatory | Basic nutrition consultation, height, weight, BMI, food allergy/intolerance, food preference | Changes of BMI, seizure frequency |
Recommended | Three-day food record/calorie count, seizure frequency before treatment, menstruation cycle monitoring | Food records/compliance, adverse effect, menstrual changes |
Laboratory | ||
Mandatory | Basic metabolism examination, liver function (if on hepatically metabolized ASMs), human chorionic gonadotropin urine test (for premenopausal females) | Basic metabolic index, blood lipids, urinalysis, urine ketones (in the case of intolerance, consider stopping KD during treatment) |
Recommended | Complete blood count, blood lipid, liver function, calcium, vitamin D, amylase, and lipase tests | Liver function, vitamin D, complete blood count, calcium, free/total carnitine, and urine ketone tests |
Serum-free carnitine, selenium, magnesium, phosphorus, ASM concentration, urinalysis, urine calcium, and creatinine ratio | Serum selenium, zinc, magnesium, phosphorus; urine calcium-to-creatinine ratio (especially when not taking citrate) | |
Diagnosis | ||
Mandatory | For patients with high suspicion of metabolic disease, diagnosis is required to determine the cause | - |
Recommended | EEG/epilepsy center evaluation (when the diagnosis is unknown or if patients are suitable for surgery) | Bone density scan (at least once every 5 years), renal ultrasound (when suspected of kidney stones), carotid ultrasound (long-term fasting with elevated blood lipids) |