Abstract
Objective The ketogenic diet (KD) has been shown to be an effective treatment option for refractory childhood epilepsy. However, this complex dietary intervention causes major metabolic changes and can evoke adverse side-effects in some children. The time and frequency of reported side-effects and therefore also the management and monitoring methods vary between practising hospitals throughout the world. Our objective was to give an overview of the occurrences of a broad range of physiological side-effects in one specific patient group and to study the influence of age and diet versions. Methods In an observational study including 68 children with refractory epilepsy and treated with the KD we investigated occurrences of adverse physiological side-effects within 1 year of follow-up, distinguishing between the short (1–3 months) and long term (4–12 months) effects. Data from blood and urine analyses were extracted from patient files and compared to reference values. Two age groups (≤3 years and 4–12 years) and two diet groups (Classic and MCT/LCT) were distinguished for statistical analysis in the form of independent samples t-tests. Results Cases of hypercalciuria (58%), hypertriglyceridemia (46%), hypoglycaemia (21%), hypercholesterolemia (21%) and hyperketosis (7%) were all seen on both the short and long term. Selenium deficiency (6%) was only found at baseline and could not be related to the KD. Ketoacidosis, carnitine deficiency and prolonged QTc-intervals were not observed. Youngest patients showed significantly higher blood ketone levels (p=0.007) and age-dependent calcium/creatinine ratios (p=0.048) than the older children. Patients on the MCT/LCT diet had significantly higher cholesterol levels (p=0.046) while patients on the classic diet had higher plasma triglycerides (p=0.02). Conclusion All detected side-effects were well-manageable and never a reason for KD discontinuation, but structured monitoring of all patients and special care of the identified risk groups are recommended.
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