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Predictive power of first morning glucose and the ketogenic diet

A G C Bergqvist1, J I Schall, E L Richard

  • 1Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, PA 19104, USA. bergqvist@email.chop.edu

Neuropediatrics
|December 7, 2007
PubMed

Insights

Blood glucose levels, including hypoglycemia and hyperglycemia, do not predict ketogenic diet (KD) effectiveness for intractable epilepsy in children. Weight loss during KD initiation was linked to hypoglycemia, but not necessary for seizure reduction.

Area of Science:

  • Neurology
  • Pediatrics
  • Metabolic Disorders

Background:

  • Intractable epilepsy (IE) in children presents significant treatment challenges.
  • The ketogenic diet (KD) is an established therapy for refractory epilepsy.
  • Predictors of KD response, particularly blood glucose fluctuations, require further investigation.

Purpose of the Study:

  • To investigate whether hypoglycemia or hyperglycemia predicts response to the ketogenic diet (KD) in children with intractable epilepsy.
  • To determine the relationship between blood glucose levels during the initial 21 days of KD and seizure reduction at 3 months.
  • To explore the association between weight changes and blood glucose levels during KD therapy.

Main Methods:

  • Fasting morning whole blood glucose was monitored daily for the first 21 days of KD initiation.
  • Weight and height were measured at baseline, discharge, and 0.5 and 1 month of KD therapy.
  • Associations between KD response (seizure reduction >50% at 3 months), glucose levels, initiation protocol, and weight status were analyzed in 45 children (age 1-12 years).

Main Results:

  • Ketogenic diet responder status was not associated with hypoglycemia, hyperglycemia, or the KD initiation protocol (fasting vs. gradual).
  • Variability in daily blood glucose levels did not predict KD response.
  • Children experiencing weight loss during KD initiation were more likely to be hypoglycemic, irrespective of the initiation protocol.

Conclusions:

  • Blood glucose fluctuations, including hypoglycemia and hyperglycemia, are not necessary for achieving significant seizure reduction with the ketogenic diet in children with intractable epilepsy.
  • Hypoglycemia during KD therapy is associated with declining weight status, independent of the initiation method.
  • The ketogenic diet can be effectively implemented to minimize side effects and maximize therapeutic outcomes in pediatric epilepsy.

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