A comprehensive review of vagal nerve stimulation use and outcome in paediatric patients at a tertiary paediatric neurology centre

Introduction: In 2009 an expert consensus guideline for the management of children on KDT was published;the majority of centres supported initiating KDT in a hospital setting In 2018 these guidelines were revisited and 92% of centres supported initiating KDT in the outpatient setting in selective situations Method: We compared the data for KDT compliance for children starting the diet across three time periods, using cessation of KDT as a proxy for adherence: (1) 2009 to 2015: 147 families were advised to start the diet in the hospital setting (2) April 2017 to February 2020: 102 families could choose to start in the hospital or home environment (3) April 2020 to June 2020: 12 families in the first 3 months of the COVID-19 'lockdown' advised to start at home All case notes of consecutive patients from three specified time periods were reviewed Percentage differences were analysed using the "N-1" Chi-squared test Results: Cessation of KDT within 3 months of initiation was a) 44/147 (30%) vs 32/102 (31%) p=0 8663 and b) 44/147 (30%) vs 5/12 (42%) p=0 3886 The numbers of children unable to complete the 3 month trial period were 15/147 (10%) vs 13/102 (12 7%) p=05057 Within the second group a higher proportion of those opting to start in hospital ceased therapy early, 6/37 (16%) compared to 7/65 (10 7%), however this was not clinically significant (p=04406) Conclusion: In the two large groups of children studied, starting KDT in the home setting was equally as effective as starting in hospital at achieving adherence at 3 months In the smaller group starting therapy remotely during the COVID restrictions there was a trend towards less adherence;this may reflect their epilepsy, change to support, teaching using remote platforms (rather than in person), difficulties accessing novel foods or small sample size