Complications of treatment of epilepsy by a ketogenic diet

Introduction. It was originally claimed that the ketogenic diet (KC) caused no major adverse effects. Few studies have been done to analyze the side-effects and complications of the KC. Objectives. To analyze the side-effects and complications seen in a group of patients on KC compared with those described in the international literature. Patients and methods. We made a prospective evaluation of 22 patients aged between one and nineteen years, over an average period of 25 months. All had some type of refractory epilepsy and had been included in a group treated following classical KC guidelines. Results. The side-effects and complications during admission were delay in onset of the ketotic state (10.5%), intolerance of the rapid onset of ketosis (21%), hypoglycaemia (47.37%), refusal to drink fluids (15.79%), lack of appetite (15.79%), and nausea and vomiting (26.31%). During treatment the serum cholesterol rose in 64.7% of the children, 40.91% were constipated, 31.82% had periods of anorexia, symptomatic metabolic acidosis occurred during intercurrent infections in 9.09%, renal calculi in 9.09%, carnitine insufficiency in 9.09% and severe complications which led to hospital admission in 21.05%. Conclusions. Our group of patients had no more side-effects or complications than those described in the literature. KC may lead to complications, especially when strict guidelines for control and follow-up are not used. However, they are usually easy to correct if detected early.