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Is ketogenic diet treatment hepatotoxic for children with intractable epilepsy?
Nur Arslan1, Orkide Guzel2, Engin Kose3
1Dokuz Eylul University, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey; Dokuz Eylul University, Izmir Biomedicine and Genome Center, Izmir, Turkey.
Insights
Long-term ketogenic diet (KD) treatment in epileptic children can lead to liver injury, steatosis, and gallstones. Regular monitoring of liver enzymes and ultrasounds is recommended to detect these adverse effects early.
Area of Science:
- Pediatric Neurology
- Gastroenterology
- Metabolic Disorders
Background:
- The ketogenic diet (KD) is an established therapy for intractable epilepsy.
- While effective, long-term KD use has been associated with potential adverse effects, including hepatic complications.
- Understanding these risks is crucial for patient management.
Purpose of the Study:
- To retrospectively evaluate the hepatic side effects of long-term ketogenic diet (KD) treatment in children with intractable epilepsy.
- To identify the incidence of liver injury, steatosis, and gallstone formation associated with KD therapy.
Main Methods:
- A retrospective analysis of 141 pediatric patients (mean age 7.1 years) on KD for over one year for intractable epilepsy.
- Collected data included serum biochemistry (liver enzymes, lipids, bilirubin, proteins) and abdominal ultrasonography at baseline and at 1, 3, 6, and 12 months post-initiation.
Main Results:
- Elevated liver enzymes (AST, ALT) were observed in three patients within one month of KD initiation.
- Hepatosteatosis was detected in three patients at the 6-month mark.
- Gallstone formation (cholelithiasis) was identified in two patients by 12 months of KD treatment.
Conclusions:
- Long-term ketogenic diet (KD) therapy in epileptic children is associated with significant hepatic side effects, including liver parenchymal injury, steatosis, and gallstone formation.
- Routine monitoring of liver function tests and abdominal ultrasonography is essential for early detection and management of these KD-induced complications.
Purpose:
Long-term ketogenic diet (KD) treatment has been shown to induce liver steatosis and gallstone formation in some in vivo and clinical studies. The aim of this retrospective study was to evaluate the hepatic side effects of KD in epileptic children.
Method:
A total of 141 patients (mean age: 7.1±4.1years [2-18 years], 45.4% girls), receiving KD at least one year for intractable epilepsy due to different diagnoses (congenital brain defects, GLUT-1 deficiency, West syndrome, tuberous sclerosis, hypoxic brain injury, etc.) were included in the study. Serum triglyceride, cholesterol, aminotransferase, bilirubin, protein and albumin levels and abdominal ultrasonography were recorded before and at 1, 3, 6, and 12 months following after diet initiation.
Results:
The mean duration of KD was 15.9±4.3months. At one month of therapy, three patients had elevated alanine and aspartate aminotransferase levels. These patients were receiving ketogenic diet for Doose syndrome, idiopathic epilepsy and GLUT-1 deficiency. Hepatosteatosis was detected in three patients at 6 months of treatment. Two of these patients were treated with KD for the primary diagnosis of tuberous sclerosis and one for Landau Kleffner syndrome. Cholelithiasis was detected in two patients at 12 months of treatment. They were receiving treatment for West syndrome and hypoxic brain injury sequelae.
Conclusion:
Long-term ketogenic diet treatment stimulates liver parenchymal injury, hepatic steatosis and gallstone formation. Patients should be monitored by screening liver enzymes and abdominal ultrasonography in order to detect these side effects.
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