[Update on the adverse effects during therapy with a ketogenic diet in paediatric refractory epilepsy]

Rev Neurol. 2018 Mar 16;66(6):193-200.
[Article in Spanish]

Abstract

Introduction: The ketogenic diet is a non-pharmacological treatment that has been used as a therapeutic alternative for the management of refractory epilepsy since 1921. It is a diet, high in fats and low in carbohydrates, which is used to treat paediatric refractory epilepsy, and is effective in around 50% of the patients that begin to follow it. It is a nutrition plan that is imbalanced in terms of both macro- and micro-nutrients, which can give rise to nutritional deficits in energy, proteins, minerals and vitamins, as well as an excess of lipids. There is therefore a risk of it causing undesirable side effects both at the outset and in later stages of the treatment.

Development: The most frequent adverse effects that may occur either in acute form or in later stages are described, and tools that can be used in their management and prevention during treatment are proposed for paediatricians and ketogenic diet teams.

Conclusions: Some adverse effects are difficult to interpret and may manifest due to involvement at different levels of the organism, thereby arousing doubts as to whether they are caused by the diet, the antiepileptic medication or by the patient's own intercurrent complications. It is important to follow the study and evaluation frequency protocol in order to detect and prevent these effects, as well as to consult reference centres in order to evaluate the cost-benefit of continuing the treatment or not.

Title: Actualizacion sobre los efectos adversos durante la terapia con dieta cetogenica en la epilepsia refractaria pediatrica.

Introduccion. La dieta cetogenica es una terapia no farmacologica que se ha usado como alternativa para el tratamiento de la epilepsia refractaria desde 1921. Es una dieta alta en grasas y baja en hidratos de carbono, que se utiliza en el tratamiento de la epilepsia refractaria pediatrica, efectiva en alrededor del 50% de los pacientes que la inician. Se trata de un plan alimentario desequilibrado tanto en macro como en micronutrientes, que puede causar deficits nutricionales en energia, proteinas, minerales y vitaminas, y exceso de lipidos, con riesgo de ocasionar efectos secundarios no deseados tanto en el inicio del tratamiento como de forma tardia. Desarrollo. Se describen los efectos adversos mas frecuentes que se presentan en forma aguda o tardiamente, y se brindan herramientas para su manejo y prevencion durante el tratamiento para pediatras y equipos de dieta cetogenica. Conclusiones. Algunos efectos adversos son de dificil interpretacion, y pueden ser manifestacion por afectacion a diferentes niveles del organismo, poniendo en duda si son secundarios a la dieta, a la medicacion antiepileptica o a intercurrencias del propio paciente. Es importante seguir el protocolo de frecuencia de estudios y evaluaciones para detectar y prevenir estos efectos, y consultar a centros de referencia evaluando el coste-beneficio de continuar o no el tratamiento.

Publication types

  • Review

MeSH terms

  • Acidosis / etiology
  • Adolescent
  • Cardiovascular Diseases / etiology
  • Child
  • Diet, Ketogenic / adverse effects*
  • Drug Resistant Epilepsy / diet therapy*
  • Dyslipidemias / etiology
  • Female
  • Gastrointestinal Diseases / etiology
  • Growth Disorders / etiology
  • Humans
  • Hypoglycemia / etiology
  • Male
  • Malnutrition / etiology
  • Nephrolithiasis / etiology
  • Osteoporosis / etiology
  • Prospective Studies