Highlights
- •KD causes hepatic side effects in 5.7% of the patients with multidrug-resistant epilepsy.
- •Aminotransferase elevation and liver steatosis are the most frequent hepatic side effects of KD.
- •Besides the high fat content of the diet, the exact mechanisms of the liver toxicity remain unknown.
Abstract
Purpose
Long-term ketogenic diet (KD) treatment has been shown to induce liver steatosis and
gallstone formation in some in vivo and clinical studies. The aim of this retrospective study was to evaluate the hepatic
side effects of KD in epileptic children.
Method
A total of 141 patients (mean age: 7.1 ± 4.1 years [2–18 years], 45.4% girls), receiving KD at least one year for intractable epilepsy
due to different diagnoses (congenital brain defects, GLUT-1 deficiency, West syndrome,
tuberous sclerosis, hypoxic brain injury, etc.) were included in the study. Serum
triglyceride, cholesterol, aminotransferase, bilirubin, protein and albumin levels
and abdominal ultrasonography were recorded before and at 1, 3, 6, and 12 months following
after diet initiation.
Results
The mean duration of KD was 15.9 ± 4.3 months. At one month of therapy, three patients had elevated alanine and aspartate
aminotransferase levels. These patients were receiving ketogenic diet for Doose syndrome,
idiopathic epilepsy and GLUT-1 deficiency. Hepatosteatosis was detected in three patients
at 6 months of treatment. Two of these patients were treated with KD for the primary
diagnosis of tuberous sclerosis and one for Landau Kleffner syndrome. Cholelithiasis
was detected in two patients at 12 months of treatment. They were receiving treatment
for West syndrome and hypoxic brain injury sequelae.
Conclusion
Long-term ketogenic diet treatment stimulates liver parenchymal injury, hepatic steatosis
and gallstone formation. Patients should be monitored by screening liver enzymes and
abdominal ultrasonography in order to detect these side effects.
Keywords
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Article info
Publication history
Published online: November 13, 2016
Accepted:
October 27,
2016
Received in revised form:
September 23,
2016
Received:
July 25,
2016
Identification
Copyright
© 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
