Abstracts

RATIONALE: Anti-epileptic efficacy of ketogenic diet (KGD) has been proved, but low tolerance and various complications still limit the wide application of this treatment. We studied the extent of early and late onset complications to evaluate the exact limitation and to provide the method to overcome complications of KGD.
METHODS: One hundred seventeen intractable childhood epilepsy patients treated by KGD from October, 1995 to October 2001 at the department of pediatrics and epilepsy center at Sang-gye Paik Hospital were involved. Mean age of the patients at the beginning of KGD was 67.0[plusminus]60.9 months (range; 7 mo. [ndash] 16 yrs.), and mean duration of KGD was 12.6[plusminus]10.4 months (range; 1 [ndash] 43 mo.). Early and late onset complications were reviewed, as well as their outcomes.
RESULTS: 1) Most common early complication was gastrointestinal symptoms such as nausea/vomiting and diarrhea associated with gastritis and fat intolerance, noticed in 46 cases (39.3%). 2) Other early complications during the first 2 months of KGD were hypertriglyceridemia in 27 patients (23.1%), transient hyperuricemia in 27 patients (23.1%), symptomatic hypoglycemia in 9 patients (7.7%), lipoid pneumonia in 6 patients (5.1%), hypomagnesemia in 6 patients (5.1%), and various infectious diseases in 8 patients (6.8%). 3) Late complications after 2 months of KGD were gastrointestinal symptoms in 34 patients (29.1%), various infectious diseases in 23 patients (19.7%), hypercholesterolemia in 23 patients (19.7%), hypertriglyceridemia in 22 patients (18.8%), osteoporosis in 18 patients (15.4%), hypomagnesemia in 14 patients(11.9%), hyperuricemia in 9 patients (7.7%), hepatitis in 7 patients (5.9%), hypoproteinemia in 5 patients (4.3%), chronic hypokalemia without acute dehydration in 5 patients (4.3%), renal stone, iron deficiency anemia and aspiration pneumonia each in 2 patients (1.7%), cardiomyopathy, secondary hypocarnitinemia, acute pancreatitis, and symptomatic hypoglycemia each in 1 patient (0.9%). 4) Twenty[ndash]one patients stopped KGD due to complications depite their therapeutic efficacies. The causes of discontinuation were serous infectious illnesses in 9 patients, gastrointestinal intolerance in 8 patients, severe osteoporosis, persistent hypomagnesemia with tetany, cardiomyopathy, and lipoid pneumonia due to aspiration each in 1 patient. 5) Growth retardation was noticed in 41 patients among 65 patients maintained over 6 months, but only 5 patients remained growth retardation after discontinuation. 6) Most of early and late onset complications were transient and successfully managed by conservative treatments. 7) KGD related deaths were presumed in 4 cases. The causes of deaths were sepsis in 2 patients, cardiomyopathy and lipoid pneumonia each in 1 patient.
CONCLUSIONS: Most of KGD complications are transient and can be easily manageable with various conservative managements, but life threatening complications should be closely monitored during follow-up.
[Supported by: Sang-gae Hospital]