The use of K.Vita in a child with an unknown epilepsy syndrome | Case study

The case study discusses a 7-year-old male with drug-resistant epilepsy (DRE) associated with an unknown epilepsy syndrome. Due to challenging behaviour, K.Vita was chosen as the first-line dietary management option instead of the ketogenic diet.

After introducing K.Vita incrementally over eight weeks, the patient showed significant improvements in seizures. This case highlights K.Vita as an effective dietary management option for DRE, particularly when the ketogenic diet is not suitable. 

Patient details and medical history  

Current age: 7-year-old.

Gender: Male. 

Family and social history

• No metabolic abnormality. 
• Trio whole genome: No clinically relevant sequence variants.
• Consanguineous parents. 
• Extended family history of childhood seizures. 

Diagnosis and relevant medical history  

Unknown epilepsy aetiology diagnosed at 5 years of age.  

History before starting K.Vita

Presented at five years of age with myoclonic atonic seizures (10-11/day) and atypical absences (uncountable). Overnight EEG showed 37 events.  

Previous generalised tonic-clonic seizures associated with febrile intercurrent illnesses from the age of 3 with possible myoclonic jerks during sleep from the age of 2 years.  

Medications  

Clobazam, Levetiracetam, Sodium Valproate, Topiramate.

Dietetic Management

Feeding route 

The patient is fed orally. 

Previous use of the ketogenic diet 

Initially referred for the ketogenic diet. However, he presented with challenging behaviour, and the dietary restriction may be difficult to adhere to. Therefore, his parents expressed a preference to delay the ketogenic diet.

Reason for implementing K.Vita 

The patient has drug-resistant epilepsy and non-pharmacological treatment options were being considered. However, due to the challenges associated with implementing a ketogenic diet, K.Vita was chosen as the first-line dietary management option instead of the ketogenic diet. 

Dietary Management with K.Vita 

Parents were advised to: 

Introduce K.Vita incrementally over an 8-week period. 

Aim for a K.Vita target amount: 120 ml pack per day¹  (1 pack contains 371 kcal, providing 20% of his daily energy requirement - daily estimated energy requirements = 1855 kcal/d²). 

Start with 15ml/day (3 x 5ml), with weekly increases of 5ml across all meals to a target of 120ml/day (3 x 40ml). 

Continue with current diet*

*The patient had a high carbohydrate intake, although he was not overly interested in food. No changes to his diet were suggested due to concerns about faltering growth and poor oral intake. The parents wished to adjust his diet to increase overall fat intake but were advised not to make changes at this time.  

Acceptability and tolerability of using K.Vita 

K.Vita was taken well without any issues or side effects.  

The average daily amount taken is 120ml - 100% of the initial target amount.  

Parents decided to give twice daily amounts of 60ml, following food.  

A plan for future medical management was agreed upon in case a return of seizures was seen following discharge to the patient's local consultant. The advice was to increase it to 180ml/day (3 x 60ml), 30% of his daily energy requirement. 

Anthropometry  

Initially, his weight was a concern due to his low appetite, which was related to Topiramate. Since including K.Vita in his diet, his weight has improved and is proportionate to his height. 

Outcomes

K.Vita was an effective alternative approach to the dietary management of DRE in this patient. 

Follow-up occurred at 8 weeks, when absence seizures had stopped, and myoclonic jerks had reduced by 50%.  

An EEG at 5 months of K.Vita initiation demonstrated a normalised EEG with no evidence of seizures.  

At the 6 month review, the absence seizures had not been seen, and myoclonic jerks were seen daily but very subtle whilst asleep. The next phase in managing this patient's epilepsy involves considering the removal of the medications that may potentially cause side effects. 

Conclusions and Key Learnings

• K.Vita can play a role in supporting patients where a ketogenic diet may not be suitable/ appropriate or as a dietary management option whilst on the waiting list for the ketogenic diet. 
• K.Vita could provide an option to patients who require non-pharmacological management of their epilepsy with few food restrictions when compared to the ketogenic diet.  
• The use of K.Vita in this patient has reduced the need for significant dietary changes and intensive healthcare professional management associated with the ketogenic diet.