Beta-Hydroxybutyrate Levels in Children Treated with the Classical Ketogenic Diet for Drug Resistant Epilepsy
Abstract number :
V.091
Submission category :
10. Dietary Therapies (Ketogenic, Atkins, etc.)
Year :
2021
Submission ID :
1826072
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Xiaoying Qiao, MD - Shenzhen Children's Hospital; Li Chen - Shenzhen Children's Hospital; Daisy Ye - University of Melbourne; Tieshuan Huang - Shenzhen Children's Hospital; Man Zhang - Shenzhen Association against Epilepsy; Yan Hu - Shenzhen Children's Hospital; Bing Li - Shenzhen Children's Hospital; Dezhi Cao - Shenzhen Children's Hospital; Zhibing Chen - Monash University; Patrick Kwan - Monash University; Ingrid Scheffer - University of Mebourne; Jiong Qin - Peking University People's Hospital; Jianxiang Liao - Shenzhen Children's Hospital
Rationale: To understand the pattern of increase in β-hydroxybutyrate (BHB) levels following the introduction of the classical ketogenic diet (KD) in patients with drug-resistant epilepsy and to define the reference range of BHB following stabilization on a KD.
Methods: Patients with drug-resistant epilepsy were commenced on the KD after fasting for 24-48 hours. Serum BHB concentrations were obtained at 7:00, 12:00, 17:00, 23:00 daily in the first week, and at one month and three months. Oral foods were introduced once BHB levels reached 2.5 mmol/L or fasting for 48 hours. Efficacy of the KD at 1 and 3 months was analyzed. BHB levels compared between responders (defined as ≥50% seizure reduction) and non-responders. Reference range for BHB was defined by data from responders.
Results: 300 patients were recruited, of which 183/300 (61%) were responders. Median BHB levels rapidly rose in the first two days of the KD, achieving the currently accepted lower level of the therapeutic range of 2.00 mmol/L (interquartile range 0.80-3.70, n=264) by 19 hours. BHB levels reached their maximum of 4.2 at 43 hours of therapy, reducing slightly by day 7, and stabilizing by 1 month. The mean BHB level in responders was 2.96±1.07 (Mean±SD, n=175) at 1 month, and 3.01±0.97 mmol/L (Mean±SD, n=172) at 3 months. 24/183 (13%) responders never achieved a BHB level of 2 mmol/L. The reference range was 1.1 mmol/L to 4.9 mmol/L. In addition the blood BHB level at 3 months did not differ between responders (3.01±0.97mmol/L, ±SD, n=172) and non-responders (3.04±0.92mmol/L, ±SD, n=71), P=0.83. Responding rate was 77.4% and 69.8% when BHB level < 2.0 mmol/L and ≧ 2.0 mmol/L respectively.
Dietary Therapies (Ketogenic, Atkins, etc.)