Elles J T M van der Louw1, Tanya J Williams2, Bobbie J Henry-Barron3, Joanne F Olieman4, Johannes J Duvekot5, Marijn J Vermeulen6, Natalja Bannink7, Monique Williams8, Rinze F Neuteboom9, Eric H Kossoff10, Coriene E Catsman-Berrevoets9, Mackenzie C Cervenka11. 1. Department of Dietetics, Erasmus MC, Rotterdam, The Netherlands. Electronic address: e.vanderlouw@erasmusmc.nl. 2. Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, USA. Electronic address: twill145@jhmi.edu. 3. Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: bjhenry@jhu.edu. 4. Department of Dietetics, Erasmus MC, Rotterdam, The Netherlands. 5. Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands. 6. Department of Pediatric Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 7. Center of Lysosomal and Metabolic Diseases, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 8. Department of Pediatric Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Center of Lysosomal and Metabolic Diseases, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 9. Department of Neurology, Erasmus MC, Rotterdam, The Netherlands. 10. Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Suite 2158, Baltimore, MD, USA. 11. Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, USA.
Abstract
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 75g carbohydrate-restriction, later reduced to 47g. Glucose levels were 4-6mmol/L and blood ketone levels ranged from 0.2 to 1.4mmol/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 30g. 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.
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 75g carbohydrate-restriction, later reduced to 47g. Glucose levels were 4-6mmol/L and blood ketone levels ranged from 0.2 to 1.4mmol/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 30g. 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.
Authors: Mackenzie C Cervenka; Susan Wood; Manny Bagary; Antoaneta Balabanov; Eduard Bercovici; Mesha-Gay Brown; Orrin Devinsky; Cherubino Di Lorenzo; Colin P Doherty; Elizabeth Felton; Laura A Healy; Pavel Klein; Magnhild Kverneland; Danielle Lambrechts; Jennifer Langer; Janak Nathan; Jude Munn; Patty Nguyen; Matthew Phillips; Kelly Roehl; Adrianna Tanner; Clare Williams; Beth Zupec-Kania Journal: Neurol Clin Pract Date: 2021-10
Authors: Eric H Kossoff; Beth A Zupec-Kania; Stéphane Auvin; Karen R Ballaban-Gil; A G Christina Bergqvist; Robyn Blackford; Jeffrey R Buchhalter; Roberto H Caraballo; J Helen Cross; Maria G Dahlin; Elizabeth J Donner; Orkide Guzel; Rana S Jehle; Joerg Klepper; Hoon-Chul Kang; Danielle A Lambrechts; Y M Christiana Liu; Janak K Nathan; Douglas R Nordli; Heidi H Pfeifer; Jong M Rho; Ingrid E Scheffer; Suvasini Sharma; Carl E Stafstrom; Elizabeth A Thiele; Zahava Turner; Maria M Vaccarezza; Elles J T M van der Louw; Pierangelo Veggiotti; James W Wheless; Elaine C Wirrell Journal: Epilepsia Open Date: 2018-05-21
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