A Proof-of-Principle, Case-Control Study to Compensate for Potential Carbohydrates in Liquid Antiseizure Drugs in Children on the Ketogenic Diet

Courtney A. Haney, Anita Charpentier, Zahava Turner, Stacey K. Bessone, Sarah C. Doerrer, Eric H. Kossoff

Research output: Contribution to journalArticle

Abstract

Introduction: Since its creation, patients on ketogenic diet are told to avoid liquid medications due to theoretical concerns of “hidden” carbohydrates. However, switching from liquid to tablet formulations can be problematic, especially for infants and young children. We theorized that increasing the daily ketogenic ratio might compensate for liquid antiseizure drug carbohydrates. Methods: Two tables were created (for 3:1 and 4:1 ketogenic ratios), with variables including daily volume of antiseizure drugs and calories. Cases were those who had their ratio increased and liquid medications continued. Children already on tablet formulations, emergency situations, were primarily those included as controls. Results: From May 2016 through August 2018, 59 children (33 cases and 26 controls) ages 0.3-14 years were started on the classic ketogenic diet. Compensated antiseizure drugs most commonly included levetiracetam, clobazam, and valproate (mean volume 16 mL/d (range: 3-62 mL/d)). Adjusted ratios for younger children and infants on a 3:1 diet ranged from 3.1 to 3.5:1 and older children on a 4:1 diet from 4.2 to 4.7:1. There was no difference between cases and controls in achieving large ketosis (76% vs 77%), weight gain (1.4 vs 1.2 kg), 1 month >50% seizure reduction (52% vs 50%), or >90% seizure reduction (30% vs 35%). Four (12%) cases had zero or small urinary ketosis, which improved when antiseizure drugs were switched to tablets or discontinued. Conclusions: This proof-of-principle study demonstrates feasibility of compensating for carbohydrates in liquid medications by increases in the daily ketogenic ratio. This ratio adjustment protocol may help ease an already complex adjustment to dietary therapy.

Original languageEnglish (US)
JournalJournal of child neurology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Ketogenic Diet
Case-Control Studies
Carbohydrates
Tablets
Ketosis
etiracetam
Pharmaceutical Preparations
Seizures
Diet
Valproic Acid
Feasibility Studies
Weight Gain
Emergencies

Keywords

  • carbohydrates
  • diet
  • epilepsy
  • ketogenic
  • ketosis
  • liquids

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

@article{b22bd240bea74b98bef46d348a2618f1,
title = "A Proof-of-Principle, Case-Control Study to Compensate for Potential Carbohydrates in Liquid Antiseizure Drugs in Children on the Ketogenic Diet",
abstract = "Introduction: Since its creation, patients on ketogenic diet are told to avoid liquid medications due to theoretical concerns of “hidden” carbohydrates. However, switching from liquid to tablet formulations can be problematic, especially for infants and young children. We theorized that increasing the daily ketogenic ratio might compensate for liquid antiseizure drug carbohydrates. Methods: Two tables were created (for 3:1 and 4:1 ketogenic ratios), with variables including daily volume of antiseizure drugs and calories. Cases were those who had their ratio increased and liquid medications continued. Children already on tablet formulations, emergency situations, were primarily those included as controls. Results: From May 2016 through August 2018, 59 children (33 cases and 26 controls) ages 0.3-14 years were started on the classic ketogenic diet. Compensated antiseizure drugs most commonly included levetiracetam, clobazam, and valproate (mean volume 16 mL/d (range: 3-62 mL/d)). Adjusted ratios for younger children and infants on a 3:1 diet ranged from 3.1 to 3.5:1 and older children on a 4:1 diet from 4.2 to 4.7:1. There was no difference between cases and controls in achieving large ketosis (76{\%} vs 77{\%}), weight gain (1.4 vs 1.2 kg), 1 month >50{\%} seizure reduction (52{\%} vs 50{\%}), or >90{\%} seizure reduction (30{\%} vs 35{\%}). Four (12{\%}) cases had zero or small urinary ketosis, which improved when antiseizure drugs were switched to tablets or discontinued. Conclusions: This proof-of-principle study demonstrates feasibility of compensating for carbohydrates in liquid medications by increases in the daily ketogenic ratio. This ratio adjustment protocol may help ease an already complex adjustment to dietary therapy.",
keywords = "carbohydrates, diet, epilepsy, ketogenic, ketosis, liquids",
author = "Haney, {Courtney A.} and Anita Charpentier and Zahava Turner and Bessone, {Stacey K.} and Doerrer, {Sarah C.} and Kossoff, {Eric H.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0883073819831179",
language = "English (US)",
journal = "Journal of Child Neurology",
issn = "0883-0738",
publisher = "SAGE Publications Inc.",

}

TY - JOUR

T1 - A Proof-of-Principle, Case-Control Study to Compensate for Potential Carbohydrates in Liquid Antiseizure Drugs in Children on the Ketogenic Diet

AU - Haney, Courtney A.

AU - Charpentier, Anita

AU - Turner, Zahava

AU - Bessone, Stacey K.

AU - Doerrer, Sarah C.

AU - Kossoff, Eric H.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Since its creation, patients on ketogenic diet are told to avoid liquid medications due to theoretical concerns of “hidden” carbohydrates. However, switching from liquid to tablet formulations can be problematic, especially for infants and young children. We theorized that increasing the daily ketogenic ratio might compensate for liquid antiseizure drug carbohydrates. Methods: Two tables were created (for 3:1 and 4:1 ketogenic ratios), with variables including daily volume of antiseizure drugs and calories. Cases were those who had their ratio increased and liquid medications continued. Children already on tablet formulations, emergency situations, were primarily those included as controls. Results: From May 2016 through August 2018, 59 children (33 cases and 26 controls) ages 0.3-14 years were started on the classic ketogenic diet. Compensated antiseizure drugs most commonly included levetiracetam, clobazam, and valproate (mean volume 16 mL/d (range: 3-62 mL/d)). Adjusted ratios for younger children and infants on a 3:1 diet ranged from 3.1 to 3.5:1 and older children on a 4:1 diet from 4.2 to 4.7:1. There was no difference between cases and controls in achieving large ketosis (76% vs 77%), weight gain (1.4 vs 1.2 kg), 1 month >50% seizure reduction (52% vs 50%), or >90% seizure reduction (30% vs 35%). Four (12%) cases had zero or small urinary ketosis, which improved when antiseizure drugs were switched to tablets or discontinued. Conclusions: This proof-of-principle study demonstrates feasibility of compensating for carbohydrates in liquid medications by increases in the daily ketogenic ratio. This ratio adjustment protocol may help ease an already complex adjustment to dietary therapy.

AB - Introduction: Since its creation, patients on ketogenic diet are told to avoid liquid medications due to theoretical concerns of “hidden” carbohydrates. However, switching from liquid to tablet formulations can be problematic, especially for infants and young children. We theorized that increasing the daily ketogenic ratio might compensate for liquid antiseizure drug carbohydrates. Methods: Two tables were created (for 3:1 and 4:1 ketogenic ratios), with variables including daily volume of antiseizure drugs and calories. Cases were those who had their ratio increased and liquid medications continued. Children already on tablet formulations, emergency situations, were primarily those included as controls. Results: From May 2016 through August 2018, 59 children (33 cases and 26 controls) ages 0.3-14 years were started on the classic ketogenic diet. Compensated antiseizure drugs most commonly included levetiracetam, clobazam, and valproate (mean volume 16 mL/d (range: 3-62 mL/d)). Adjusted ratios for younger children and infants on a 3:1 diet ranged from 3.1 to 3.5:1 and older children on a 4:1 diet from 4.2 to 4.7:1. There was no difference between cases and controls in achieving large ketosis (76% vs 77%), weight gain (1.4 vs 1.2 kg), 1 month >50% seizure reduction (52% vs 50%), or >90% seizure reduction (30% vs 35%). Four (12%) cases had zero or small urinary ketosis, which improved when antiseizure drugs were switched to tablets or discontinued. Conclusions: This proof-of-principle study demonstrates feasibility of compensating for carbohydrates in liquid medications by increases in the daily ketogenic ratio. This ratio adjustment protocol may help ease an already complex adjustment to dietary therapy.

KW - carbohydrates

KW - diet

KW - epilepsy

KW - ketogenic

KW - ketosis

KW - liquids

UR - http://www.scopus.com/inward/record.url?scp=85061965614&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061965614&partnerID=8YFLogxK

U2 - 10.1177/0883073819831179

DO - 10.1177/0883073819831179

M3 - Article

C2 - 30782060

AN - SCOPUS:85061965614

JO - Journal of Child Neurology

JF - Journal of Child Neurology

SN - 0883-0738

ER -