The effects of classic ketogenic diet on serum lipid profile in children with refractory seizures

Abstract

More than 25 % of children with epilepsy develop refractory seizures unresponsive to both old and new generation anticonvulsants. Since such seizures have a serious negative impact on the quality of life, other treatment options are considered. The ketogenic diet is a well-known treatment for managing refractory seizures, although its mechanism of action is unknown. Studies have shown that this diet is as good as, or better than, any of the newer medications in reducing seizure frequency. However, concerns about adverse effects have been raised. We conducted an open label trial to show the effects of this diet on serum lipid profile. Thirty-three children with refractory epilepsy were treated with the ketogenic diet and were followed for 6 months. Their serum lipid profile was assessed at baseline, and at 3 and 6 months after initiating the diet. Seizure frequency was reduced in 63 % of children (no seizures in 2/33 and reduced >50 % in 19/33). However, after 6 months of administering the diet, median triglyceride was significantly increased (from 84 to 180 mg/dl, P < 0.001), median total cholesterol was significantly increased (from 180 to 285 mg/dl, P < 0.001), median serum low-density lipoprotein (LDL) was significantly increased (from 91 to 175 mg/dl, P < 0.001), and median serum high-density lipoprotein (HDL) was significantly increased (from 51 to 58 mg/dl, P < 0.001). Results of this study indicate that a classic ketogenic diet in children with refractory seizures is effective in seizure reduction, but leads to development of hypercholesterolemia and hypertriglyceridemia.

Efficacy of a ketogenic diet with concomitant intranasal perillyl alcohol as a novel strategy for the therapy of recurrent glioblastoma

“…These results are not consistent with other studies (44)(45)(46), which concluded that KD increased the serum levels of total lipids and LDL-C. However, Sharma et al (47) did not observe significant alterations to the lipid profile of children with refractory epilepsy treated with KD, which remained within normal limits throughout the study.…”

Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group

“…Hyperlipidemia is a well-known side effect of almost all KDT. 137,[145][146][147][148] Increased serum triglycerides and total and low-density lipoprotein (LDL) cholesterol levels have been reported in 14-59% of children on the classic KD. 129,137,147,148 Hyperlipidemia can be seen as early as the first month of therapy.…”

The efficacy of the ketogenic diet in infants and young children with refractory epilepsies using a formula-based powder

“…Eligible patients were those children aged between 12 months and 5 years with refractory seizures or refractory epilepsy syndromes, who had at least two episodes of seizures weekly while taking a combination of 3 or more appropriately selected anticonvulsants [15]. Included children had to be chosen to receive a 4:1 classic ketogenic diet, and had to be reluctant to eat homemade foods according to the rules of the ketogenic diet.…”

“…Many case series, open label studies, and at least one randomized controlled trial have shown their efficacy in children with refractory epilepsies [2,5,7,8,[12][13][14][15][16]. Notably, some authors believe that a ketogenic diet is more effective than most of the newer anticonvulsive medications [16,17].…”

“…In Iran, two major child neurology centers administer the classic 4:1 ketogenic diet under direct supervision of skilled nutritionists and trained staff [15]. Although many families are cooperative enough to continue to administer the ketogenic diet in their homes, a number of families find it difficult due to the need to weigh foods and flavor them.…”