Incidence of potential adverse events during hospital‐based ketogenic diet initiation among children with drug‐resistant epilepsy

Abstract

Objective Due to the possibility of serious adverse events (AE), patients are commonly admitted to hospital for 3‐5 days for ketogenic diet (KD) initiation. This study examined the incidence of potential AE during admission for KD initiation to investigate the possibility of safely initiating a KD at home. Methods Children with drug‐resistant epilepsy (DRE) who were admitted to hospital for 5 days for KD initiation were retrospectively studied. Results A total of 66 children (59% female) were analyzed. The mean age at the initiation of the KD was 48.0 ± 38.4 months, and the mean weight was 14.6 ± 6.3 kg. The median number of anticonvulsant medications used at the time of KD initiation was 3. The etiology of the DRE was structural in 4.5%, hypoxic ischemic encephalopathy in 10.6%, genetic/metabolic in 31.8%, acquired in 10.6%, and unknown in 42.2%. The potential AE occurred in 28.7% of patients, including hypoglycemia (20%), hypoactivity (6.1%), somnolence (3%), and vomiting (7.6%). A univariate analysis of the clinical characteristics of the AE and no AE groups showed a statistically significant difference in weight (P = 0.003) and age (P = 0.033). The concurrent use of topiramate was found to have a near‐significant association (P = 0.097) between the groups. The groups' urine ketone levels on all 5 days were compared, and a statistically significant difference was found on day 3 (P = 0.026). A statistically significant difference in the serum bicarbonate levels (P = 0.038) was found between the patients taking topiramate and those not taking it. Significance The incidence of AE during admission for KD initiation was found to be low. The AE either required no intervention or were easily managed with simple interventions. Thus, in carefully selected patients, it may be possible to initiate a KD at home if the parents are adequately prepared and monitored.

Ketogenic diet as elective treatment in patients with drug-unresponsive hyperinsulinemic hypoglycemia caused by glucokinase mutations

“…Normoinsulinemic individuals are at risk of developing hypoglycemia in the induction phase of KD, in a proportion ranging from 1 to 28% [30,32,33]. In our HI patients, the glycemic control worsened in two out of three under KD.…”

“…Patient 2, who experienced worsening of hypoglycemia (because of low carbohydrate intake) and hypoactivity during the induction phase, had a normal EEG activity with a ketonemia on target, to witness of a direct neuroprotective effect of ketone bodies at short-term. However, in the induction phase of KD, hypoactivity has been reported in a few percentage of cases, independently from hypoglycemia [30]. Administration of glucose infusion would have suppressed ketogenesis.…”

“…Therefore, the child was treated with single intramuscular glucagon and continuous intravenous glucagon infusion, the first giving a transient response, the latter being ineffective. The reduced intake of carbohydrates from KD reduces the hepatic glycogen content [31], indeed subjects under KD are at risk of hypoglycemia in the induction phase [30,32,33]. A single injection of glucagon is likely more efficacious to elicitate glycogenolysis from the poor hepatic glycogen reserves, than continuous glucagon administration, which might contribuite to their exhaustion, blunting its own response.…”

The use of ketogenic diets in children living with drug‐resistant epilepsy, glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency: A scoping review

“…The most common research type was retrospective cohort study (39.4%, n = 126), 69–194 followed by prospective cohort study (21.9%, n = 70) 195–264 . The remaining quantitative study designs included case series (10.7%, n = 34),…”