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Ketogenic Diet in Neonates with Drug-Resistant Epilepsy: Efficacy and Side Effects-A Single Center's Initial
Raffaele Falsaperla1,2, Vincenzo Sortino2,3, Ausilia Desiree Collotta2,3
1Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco," San Marco Hospital, University of Catania, Catania, Italy.
Insights
The ketogenic diet shows efficacy in infants with drug-resistant epilepsy treated in the neonatal intensive care unit (NICU). Careful management of side effects is crucial for optimizing this ketogenic treatment.
Area of Science:
- Pediatric Neurology
- Metabolic Therapies
- Neonatal Care
Background:
- Pharmacoresistant epilepsy in infants, especially neonates in the NICU, has limited treatment options.
- The ketogenic diet is a recognized therapy for epilepsy, but data in very young infants is scarce.
Purpose of the Study:
- To assess the short-term (3-month) effectiveness and safety of the ketogenic diet in infants with drug-resistant epilepsy.
- To evaluate outcomes for infants treated with the ketogenic diet during NICU hospitalization.
Main Methods:
- Retrospective study of infants under 2 months old initiated on a ketogenic diet for drug-resistant epilepsy.
- Data collected from April 2018 to November 2022 for infants hospitalized in the NICU.
Main Results:
- Ten infants were included after excluding non-responders; 40% showed a good response to the ketogenic diet.
- Four patients discontinued the diet due to adverse effects, with significant changes noted in electrolytes, pH, and gastrointestinal symptoms.
- Higher ketonuria and lower blood pH were observed in infants on more than three antiepileptic drugs.
Conclusions:
- The ketogenic diet can be effective and safe for infants with epilepsy.
- Early and proactive management of adverse reactions is essential for enhancing the safety and efficacy of ketogenic therapy in this population.
Background:
For patients with pharmacoresistant epilepsy, a therapeutic option is ketogenic diet. Currently, data on young infants are scarce, particularly during hospitalization in the neonatal intensive care unit (NICU).
Objective:
The aim of the present study was to evaluate the short-term (3-month) efficacy and side effects of ketogenic diet in infants with "drugs-resistant" epilepsy treated during NICU stay.
Methods:
This retrospective study included infants aged under 2 months started on ketogenic diet during NICU hospitalization to treat drug-resistant epilepsy from April 2018 to November 2022.
Results:
Thirteen term-born infants were included, three (23.1%) of whom were excluded because they did not respond to the ketogenic diet. Finally, we included 10 infants. Six (60%) patients took three antiepileptics before starting the ketogenic diet, while four (40%) took more drugs. Diet had a good response in four (40%) patients. In four patients, the ketogenic diet was suspended because of the onset of serious side effects. The emetic levels of sodium, potassium, and chlorine, pH, and onset of diarrhea, constipation, and gastroesophageal reflux showed significant differences. Ketonuria was higher and blood pH lower in the group that took more than three drugs than in the group taking fewer than three drugs.
Conclusion:
The ketogenic diet is efficacious and safe in infants, but the early and aggressive management of adverse reactions is important to improve the safety and effectiveness of the ketogenic treatment.
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