Monitoring Glucose Concentrations in Children with Epilepsy on a Ketogenic Diet

Abstract

Ketogenic diet (KD) and pulsatile dexamethasone therapy (PDT) are commonly used in the treatment of children with drug resistant epilepsy. Potential side effects of the KD are hypoglycemia, whereas PDT might lead to hyperglycemia. One practical option to measure glucose concentrations regularly is the flash glucose monitoring system (FGM). In this single-center study in Germany, two pediatric patients with epilepsy (age: 6.0 and 6.8 years) received FGM from the beginning of the KD over six months, in the year 2020, and one patient (9.8 years) was observed for one month on PDT and switched to the KD thereafter. Glucose concentrations were measured by using an FGM system and capillary blood measurement. Seizure frequency, changes in cognition, motor performance, social behavior, and sleep quality were evaluated. The mean hypoglycemia rate per day (65 mg/dL and lower) declined significantly in patient 1 and 2 after three months. Patient 3 showed in total seven hyperglycemic events during PDT. Patient 1 became seizure free. Improvement of attention and memory performance were reported. FGM during the KD as a treatment for drug resistant epilepsies in childhood is a practical option to explore and to avoid hypoglycemia during the KD and hyperglycemia during PDT.

Dynamics of glucose concentration during the initiation of ketogenic diet treatment in children with refractory epilepsy: Results of continuous glucose monitoring

“…3 Common side-effects of KD include nausea and vomiting, acidosis, dehydration, and hypoglycemia. 1 Although transient hypoglycemia during the introduction of the KD is well documented, [4][5][6] and longer term hypoglycemic episodes were found in several KD patients 7,8 suggesting substantial changes in glucose concentrations, detailed dynamics of glucose concentration during KD treatment has never been studied.…”