Abstracts

Rationale: Ketogenic diet therapy, a mainstay in the treatment of intractable epilepsy in primarily children for nearly a century and in the treatment of obesity for over 50 years, has demonstrated increasing therapeutic potential for a wide number of pathological conditions in both children and adults.  One barrier to dietary treatment in adults is the negative perception in the health care community regarding the potential risk of dyslipidemia and exacerbating co-morbid conditions such as obesity and cardiovascular disease (CVD).  The current study investigated an extended cardiovascular risk profile, both biochemical and vascular, of adult epilepsy patients treated with long-term ketogenic diet therapy compared to controls. Methods: Anthropometric measures, serum fasting lipid panel, apolipoproteins A-1 (apoA1) and B (apoB), and low-density lipoprotein (LDL) cholesterol sub-fractions as well as common carotid intima media thickness (cIMT) and plaque presence were assessed in twenty adult epilepsy patients who received modified Atkins diet (MAD) therapy for > 1 year compared to twenty-one adult epilepsy patients naïve to diet therapy. Results: Patients treated with MAD had significantly lower weight (p=0.023), body mass index (p=0.009), waist circumference (p=0.031), hip circumference (p=0.002), percent body fat (p=0.033), and serum triglyceride levels (p=0.024) when compared to control patients.  In contrast, patients treated with MAD had significantly higher serum levels of small LDL particles (p=0.023) and were significantly more likely to have LDL pattern B, in which small LDL particles predominate, when compared to controls (p=0.025).  There were no significant differences between groups in levels of total cholesterol, HDL (high-density lipoprotein) cholesterol, LDL, apoB/A1 ratio, or total number of LDL particles.  Small LDL particles are associated with increased CVD risk and atherogenesis as they cross the arterial wall more readily and are more easily oxidized.  However, no significant differences in cIMT or plaque presence were seen between groups. Conclusions: These results provide preliminary evidence demonstrating the safety of a high fat, low carbohydrate diet used in adults with epilepsy for at least 12 months.  The study also highlights potential markers of CVD risk – small dense LDL particles - that should be more closely monitored in patients treated with diet therapy long-term.  Further prospective studies examining the long-term impact of increased small dense LDL particles in this population are warranted. Funding: The Center for Refractory Status Epilepticus and NeuroinflammationChristopher Garrod and Dawn Griffiths (Philanthropic Support)            Co-PI: Cervenka MC and Probasco J09/01/2015-09/01/2018Role: Collaborating Investigator