TY - JOUR
T1 - Ketogenic diet therapy for epilepsy during pregnancy
T2 - A case series
AU - van der Louw, Elles J.T.M.
AU - Williams, Tanya J.
AU - Henry-Barron, Bobbie J.
AU - Olieman, Joanne F.
AU - Duvekot, Johannes J.
AU - Vermeulen, Marijn J.
AU - Bannink, Natalja
AU - Williams, Monique
AU - Neuteboom, Rinze F.
AU - Kossoff, Eric H.
AU - Catsman-Berrevoets, Coriene E.
AU - Cervenka, Mackenzie C.
N1 - Publisher Copyright:
© 2017 British Epilepsy Association
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Purpose Evaluation of ketogenic diet (KD) therapies for seizure control during pregnancy when safety and appropriate management become considerations. Until now, no information has been available on seizure reduction and human pregnancy related outcomes in women treated with KD therapies. Method We describe two cases of pregnant women with epilepsy treated with KD therapy either as monotherapy (Case 1) or as adjunctive therapy (Case 2). Results Case 1: A 27 year old woman, gravida1, started the classic KD with medium chain triglyceride (MCT) emulsion and 75 g carbohydrate-restriction, later reduced to 47 g. Glucose levels were 4–6 mmol/L and blood ketone levels ranged from 0.2 to 1.4 mmol/L. Seizure frequency decreased and seizure-free days increased. Mild side effects included intolerance to MCT, reduced serum carnitine and vitamin levels, and mild hyperlipidemia. Fetal and neonatal growth was normal as was growth and development at 12 months. Case 2: A 36 year-old nulliparous woman was treated with a 20 gram carbohydrate-restricted Modified Atkins Diet (MAD) and lamotrigine, resulting in reduction of seizure frequency to once per month prior to pregnancy. Once pregnant, carbohydrates were increased to 30 g. When seizures increased, lamotrigine dose was doubled. Urine ketones trended down during second trimester. A male was born with bilateral ear deformities of unknown significance. The child had a normal neurodevelopment at eight months. Conclusion Non-pharmacological epilepsy therapies like KD and MAD may be effective during human pregnancy. However, safety still has to be established. Further monitoring to identify potential long term side effects is warranted.
AB - Purpose Evaluation of ketogenic diet (KD) therapies for seizure control during pregnancy when safety and appropriate management become considerations. Until now, no information has been available on seizure reduction and human pregnancy related outcomes in women treated with KD therapies. Method We describe two cases of pregnant women with epilepsy treated with KD therapy either as monotherapy (Case 1) or as adjunctive therapy (Case 2). Results Case 1: A 27 year old woman, gravida1, started the classic KD with medium chain triglyceride (MCT) emulsion and 75 g carbohydrate-restriction, later reduced to 47 g. Glucose levels were 4–6 mmol/L and blood ketone levels ranged from 0.2 to 1.4 mmol/L. Seizure frequency decreased and seizure-free days increased. Mild side effects included intolerance to MCT, reduced serum carnitine and vitamin levels, and mild hyperlipidemia. Fetal and neonatal growth was normal as was growth and development at 12 months. Case 2: A 36 year-old nulliparous woman was treated with a 20 gram carbohydrate-restricted Modified Atkins Diet (MAD) and lamotrigine, resulting in reduction of seizure frequency to once per month prior to pregnancy. Once pregnant, carbohydrates were increased to 30 g. When seizures increased, lamotrigine dose was doubled. Urine ketones trended down during second trimester. A male was born with bilateral ear deformities of unknown significance. The child had a normal neurodevelopment at eight months. Conclusion Non-pharmacological epilepsy therapies like KD and MAD may be effective during human pregnancy. However, safety still has to be established. Further monitoring to identify potential long term side effects is warranted.
KW - Ketogenic diet
KW - Ketosis
KW - Modified Atkins Diet
KW - Non-pharmacological
KW - Pregnancy
KW - Women
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U2 - 10.1016/j.seizure.2016.12.019
DO - 10.1016/j.seizure.2016.12.019
M3 - Article
C2 - 28110175
AN - SCOPUS:85009810544
SN - 1059-1311
VL - 45
SP - 198
EP - 201
JO - Seizure
JF - Seizure
ER -