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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
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
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)
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)
  1. ASM anti-seizure medication, BMI body-mass index, EEG electroencephalogram, KD ketogenic dietary