Complications during Ketogenic diet Initiation: Prevalence, Treatment and Influence on Seizure outcomes

Publication date: Available online 16 January 2017
Source:Pediatric Neurology
Author(s): Abigail Lin, Zahava Turner, Sarah C. Doerrer, Anthony Stanfield, Eric H. Kossoff
IntroductionMany centers still admit children for several days to start the ketogenic diet (KD). The exact incidence of adverse effects during the admission, as well as their potential later impact on seizure reduction, has not been widely studied.MethodsWe performed a retrospective study of children with intractable epilepsy electively admitted for KD initiation at our institution from 2011-2016. Charts were reviewed for adverse effects during the admission period and then examined for seizure reduction and compliance at 3 months. A rating scale (1-4) was created for severity of any adverse events.Results158 children were included, mean age 4.6 years. Potentially attributable adverse effects occurred in 126 (80%), most commonly emesis, food refusal, and hypoglycemia. Seventy-three (46%) received some form of intervention by the medical team, most commonly juice (24%). Younger age was correlated with an increased likelihood of moderate-severe adverse effects during admission, often repeated hypoglycemia (3.6 versus 4.9 years, p=0.04). Fasting was more likely to result in lethargy and a single blood glucose in the 30-40 mg/dL range, but was not correlated with emesis, repeated hypoglycemia, or higher adverse effect scores. There was no statistically significant correlation between the severity of adverse effects and 3-month seizure reduction.ConclusionsMild, easily-treated adverse effects were seen in the majority of children admitted for the ketogenic diet. Younger children were at greater risk for significant difficulties, and should be monitored closely. As fasting led to more lethargy and hypoglycemia, it may be prudent to avoid this in younger children.



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