Open AccessKetogenic parenteral nutrition in 17 pediatric patients with epilepsy
Author(s) -
Dressler Anastasia,
Haiden Nadja,
TrimmelSchwahofer Petra,
Benninger Franz,
Samueli Sharon,
Gröppel Gudrun,
Spatzierer Sina,
Mühlebner Angelika,
Abraham Klaus,
Feucht Martha
Publication year - 2018
Publication title -
epilepsia open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.247
H-Index - 16
ISSN - 2470-9239
DOI - 10.1002/epi4.12084
Subject(s) - ketogenic diet , medicine , ketosis , parenteral nutrition , enteral administration , pediatrics , adverse effect , hypoglycemia , vomiting , gastroenterology , status epilepticus , epilepsy , endocrinology , insulin , diabetes mellitus , psychiatry
Summary Objective Ketogenic parenteral nutrition ( kPN ) is indicated when enteral intake is temporarily limited or impossible, but evidence‐based prescriptions are lacking. Objective was to evaluate the efficacy and safety of kPN in children with epileptic encephalopathies using a new computer‐based algorithm for accurate component calculating. Methods Children with epilepsy receiving kPN were included. A computer‐based algorithm was established on the basis of guidelines of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition ( ESPGHAN ): fat intake not exceeding 4 g/kg/day, age‐adequate supply of protein, electrolytes, vitamins, and trace elements, but reduced carbohydrates. Primary outcome was successfully reaching relevant ketosis, defined as beta‐hydroxybutyrate plasma level of ≥ 2 mmol/L. Efficacy was defined as seizure reduction ≥50% in de novo kPN and maintenance of response in children already on a ketogenic diet ( KD) . Safety was assessed by adverse effects, laboratory findings, and the appropriateness of nutritional intake. Results Seventeen children (median 1.84 years) were studied, of which 76% (13/17) were already on an oral ketogenic diet. Indications for kPN were surgery, status epilepticus, vomiting, food refusal, and introduction of enteral feeding in neonates. The parenteral fat/nonfat ratio was mean 0.9 (±0.3; range 0.6–1.5). Relevant ketosis was reached in 10 children (median 2.9 mmol/L), but not in 7 (median = 1.4 mmol/L). In de novo kPN , significant response was observed in 50% (2/4); in patients previously responding to the KD (77%, 10/13), response was maintained. A significant correlation between the degree of ketosis and seizure reduction (correlation coefficient = 0.691; p = .002) was observed. Only mild and transient adverse events occurred during kPN . Significance KPN with fat intake of 3.5–4.0 g/kg/day was safe and effective. KPN was tailored according to guidelines and individual nutritional needs. In nearly half of the patients, ketosis was lower than during oral KD . Despite this, seizures remained controlled.