Monitoring Glucose Concentrations in Children with Epilepsy on a Ketogenic Diet.

Katharina Schiller,Martin Klingelhöfer,Markus Rauchenzauner,Mirjam Kunz,Aline Kortas,Gabriele Unterholzner,Tamir Avigdor

doi:10.3390/healthcare10020245

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.

Highlights

Epilepsy is one of the most common neurological diseases found in childhood
Patient 1 had a total amount of 1979 glucose concentration measurements (Mean ± SD: 74.8 mg/dL ± 12.5 mg/dL; min: 34 mg/dL, max: 134 mg/dL) registered over the observational period of six months
Our results showed that hypoglycemia is an adverse effect especially when starting the Ketogenic diet (KD)

Summary

Introduction

Epilepsy is one of the most common neurological diseases found in childhood. Up to one third of the patients with epilepsy treated show pharmaco-resistance [1]. One frequently used and effective treatment for drug resistant epilepsies in childhood is the Ketogenic diet (KD), comprising a high amount of fat and low percentage of carbohydrates [2]. In a review by Rezaei et al evaluating the success of the KD, the majority of the children and adolescents showed a 50% decrease in seizure frequency up to seizure freedom, during the first six months after beginning the KD [3]. The KD was shown to be effective and well-tolerated in infants with intractable epilepsy [4]. A very low-calorie KD was used as a therapeutic approach for many diseases, such as epilepsy or obesity [3,5,6]

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Conclusion