Related Experiment Video
Updated: Aug 6, 2026
Microdialysis of Excitatory Amino Acids During EEG Recordings in Freely Moving Rats
Published on: November 8, 2018
Predicting the efficacy of classic ketogenic diet therapy in children with refractory epilepsy using dynamic changes
Jiang Li1, Tianqi Wang2, Lifei Yu2
1Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, 410007, China.
Insights
Early monitoring of the glucose-ketone index (GKI) can predict classic ketogenic diet (CKD) efficacy in children with refractory epilepsy. A high GKI on day one suggests a poor response, enabling timely intervention adjustments.
Area of Science:
- Pediatric Neurology
- Metabolic Disorders
- Epilepsy Management
Background:
- Refractory epilepsy in children poses significant treatment challenges.
- The classic ketogenic diet (CKD) is an established therapy for drug-resistant epilepsy.
- Predicting CKD efficacy early is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the predictive value of dynamic changes in blood glucose, blood ketones, and the glucose-ketone index (GKI) for CKD efficacy in pediatric refractory epilepsy.
- To identify early metabolic indicators of treatment response.
Main Methods:
- Retrospective analysis of 189 children with refractory epilepsy on CKD.
- Monitoring of blood glucose, blood ketones, and GKI at multiple time points during the initial phase of CKD.
- Classification of patients into responder and non-responder groups based on seizure reduction and Engel's classification.
Main Results:
- The GKI on the first day of CKD therapy was the best single predictor of efficacy (AUC = 0.638, cut-off 9.63).
- Combining blood glucose (<4.95 mmol/L) and blood ketone (>0.75 mmol/L) levels showed improved predictive performance (AUC = 0.661).
Conclusions:
- A GKI > 9.63 on the first day of CKD therapy may indicate a poor treatment response.
- The initial phase of CKD is critical for metabolic adaptation.
- Monitoring dynamic GKI and ketone levels can guide early intervention adjustments for improved efficacy.
Objective:
To investigate the predictive value of dynamic changes in blood glucose, blood ketones and glucose-ketone index (GKI) for the efficacy of the classic ketogenic diet (CKD)in children with refractory epilepsy.
Methods:
Data from 189 children with refractory epilepsy who received classic ketogenic diet (CKD) between January 2018 and December 2024 were retrospectively analyzed. Blood glucose, blood ketones and the glucose-ketone index (GKI) which defined as the ratio of blood glucose to blood ketone were monitored at multiple time points, from the 2-day period of halving carbohydrate intake to 90 days after CKD initiation. Patients were divided into a responder group (≥50% seizure reduction) and a non-responder group based on Engel's classification after three months of treatment. Group differences in metabolic indices were assessed, and receiver operating characteristic (ROC) analysis identified optimal GKI thresholds for predicting response.
Results:
On the first day of CKD therapy, GKI (AUC = 0.638) was the best single predictor of efficacy among all time points, with a cut-off value of 9.63 (sensitivity and specificity both 0.63). Combining blood glucose (<4.95 mmol/L) and blood ketone (>0.75 mmol/L) levels improved predictive performance (AUC = 0.661).
Conclusion:
A GKI > 9.63 on the first day of CKD therapy may serve as an early-warning indicator of poor treatment response. The early treatment phase-from the second day of halving carbohydrate intake to the first day of CKD-represents a critical window for metabolic transition. Monitoring dynamic changes in GKI and blood ketone may facilitate timely adjustment of intervention strategies.
Related Concept Videos
01:22Diabetic Ketoacidosis ll: Pathophysiology
01:25Diabetic Ketoacidosis l: Introduction
01:15Hypoglycemia and Glucagon