Abstracts

The purpose of this study was to determine if hypoglycemia or hyperglycemia predicts clinical ketogenic diet (KD) response by evaluating first morning blood glucose during the initial 21 days after initiation of the KD in a cohort of children with intractable epilepsy. In addition, the correlation between change in weight status and blood glucose was explored., First morning fasting whole blood glucose was measured daily for the first 21 days after KD initiation. Moderate hypoglycemia was defined as a glucose [lt] 60 mg/dL at any time during the 21 days; severe hypoglycemia as [lt] 45 mg/dL; and hyperglycemia as [gt] 100 mg/dL. Z-scores for weight (WAZ) and height (HAZ) were obtained at baseline, the day of discharge, 0.5 and 1 month of full KD therapy. Associations between clinical response to the KD, responder defined as [gt] 50% reduction of seizure frequency at 3 months, hypoglycemia, hyperglycemia, style of KD initiation (fasting or gradual) and weight status were evaluated using Fisher[apos]s exact test and longitudinal mixed effects models., Forty-five subjects ages 1 to 12 years (mean age 5.3 [plusmn] 2.7 y) participated. Growth status was suboptimal before KD initiation (WAZ -0.3 [plusmn] 1.6 and HAZ -0.4 [plusmn] 2.0). Weight status declined over 1 month of KD therapy (to -0.6 [plusmn] 1.7 for WAZ). KD responder status was not associated with low or elevated blood glucose. A fasting or gradual KD initiation was also not associated. Children who had declining weight status during KD initiation were more likely to be hypoglycemic during full KD therapy, but this was unrelated to response to KD., Low blood glucose during KD therapy was not necessary for response to KD with clinically significant seizure reduction. Hypoglycemia was related to declining weight status. An effective KD can be provided in a manner to minimize side-effects and maximize efficacy.[table1], (Supported by: This study was supported in part by RRK-23 16074 and General Clinical Research Center (MO1RR00240), the Nutrition Center of the Children[apos]s Hospital of Philadelphia, and the Catharine Brown Foundation.)