Efficacy and tolerability of the modified Atkins diet in adults with pharmacoresistant epilepsy: a prospective observational study.

PURPOSE: Evidence from the pediatric population exists for the efficacy of ketogenic diets in reducing seizure frequency in patients with intractable epilepsy. Recent evidence suggests that a Modified Atkins Diet may be a beneficial form of cotherapy for adult patients with pharmacoresistant epilepsy. METHODS: A prospective, open-label study was performed of adults > 18 years of age with pharmacoresistant epilepsy. Carbohydrates were restricted to 20 g/day. Fluids and calories from protein and fat were allowed ad libitum. KEY FINDINGS: Eighteen patients, ages 18-55 years, were initially enrolled. Using an intent-to-treat analysis, 12% had a >50% seizure reduction after 3 months; 28% after 6 months, and 21% after 12 months. Response at 3 months predicted response at 12 months in 79% of patients. The mean decrease in weight was 10.9 kg and the mean decrease in body mass index (BMI) was 3.8, p = 0.01. Fourteen of 18 patients (78%) completed 12 months of this diet. Patients experienced a decrease in triglycerides from (mean) 1.22 to 0.9 mm (p = 0.02). SIGNIFICANCE: The Modified Atkins Diet demonstrates modest efficacy as cotherapy for some adults with pharmacoresistant epilepsy and may be also helpful for weight loss. Financial and logistical barriers were significant factors for those who declined enrollment and for those who discontinued the study.

Are enterally fed ICU patients meeting clinical practice guidelines?

BACKGROUND: The 2003 Canadian clinical practice guidelines (CPGs) for nutrition support in mechanically ventilated, critically ill patients recommended early EN and maintaining a 45-degree head-of-bed (HOB) angle during EN administration. Current practices at University Health Network have not been examined with regard to these guidelines. The purpose of this study was to determine the proportion of mechanically ventilated, enterally fed intensive care unit patients meeting the CPG recommendations for early EN and HOB elevation. METHODS: This was a cross-sectional study involving data collection in 2 parts. Early EN data were collected via chart review and HOB data through observation of HOB angle reader. Reasons for not meeting each recommendation were obtained when data were collected via chart review and feedback from nurses. data analysis was conducted using frequency distributions. RESULTS: sixty-six percent of patients met the recommendation for early en. of those not meeting this recommendation, the most common reason for the delay was hemodynamic instability (28.1%). for the hob recommendation, 4.9% of patients met the 45 degree recommendation, and 52.5% had an hob angle between 21 and 30 degrees. the most common reason for not attaining the 45-degree angle was reported as unknown (29.5%). CONCLUSIONS: The proportion of patients meeting clinical practice guidelines compares favorably to similar studies. In some cases, patients' clinical conditions or unit HOB angle protocol explained not meeting guidelines. However, there were cases where reasons for not meeting guidelines were unknown.