Background: Diet therapy is crucial for treating drug-refractory epilepsy. Evaluating compliance is vital, with manual record-keeping considered the gold standard despite its cumbersome nature.

Objective: To assess if there are any correlation between knowledge and understanding of diet therapy among parents and compliance assessment via manual recording in children <2 years of age with West syndrome.

Methods and Materials: This prospective study involved 43 children with West syndrome initiating a ketogenic diet at a 2:1 ratio on day 1, escalating to 3:1 by day 3, for a minimum of 6 weeks. At 6 months, parental comprehension of diet therapy was evaluated using a 25-question questionnaire, comparing it with manual records of feeds and urine ketosis. An adequate knowledge score ≥17 (70%) and compliance score ≥80% with 2+ ketosis were considered indicative of good compliance.

Results: Among the 43 children enrolled, 1 patient withdrew consent before starting. 4 patients had lost to follow up. Among the remaining 38 patients good compliance score was seen in 35/38(92%) while satisfactory knowledge and understanding score was seen only in 23/38(61%) patients(p-0.001). “KD is a low fat, high protein, moderate-carbohydrate diet” and “Carbohydrates are the main dietary source converted into ketone bodies” were the questions frequently erred by >75% of the respondents. 16/38 questions had >70% correct response rates.

Conclusion: While challenging, daily diary counting and urine ketone assessment stand as gold standard methods for compliance evaluation. Successful diet therapy requires parents' self-motivation and diligent follow-up. Regular assessments of parental knowledge enhance ongoing compliance improvement.

Sheffali Gulati
All India Institute of Medical Sciences
India

Aakash Mahesan
All India Institute of Medical Sciences
India

Anuja Agarwala
All India Institute of Medical Sciences
India

Kanak Lata Gupta
All India Institute of Medical Sciences
India

Gautam Kamila
All India Institute of Medical Sciences
India

Vishal Sondhi
Armed Forces Medical College
India

Prashant Jauhari
All India Institute of Medical Sciences
India

Biswaroop Chakrabarty
All India Institute of Medical Sciences
India