title: Breath acetone predicts plasma ketone bodies in children with epilepsy on a ketogenic diet.
abstract: OBJECTIVE
  The high-fat ketogenic diet has long been used to treat refractory childhood seizures, but whether there is a relation between the degree of ketosis and effectiveness of seizure control remains unclear. Frequent measurements of plasma ketones are difficult in children so the goal was to determine the utility of breath acetone as a marker of systemic ketosis and seizure control in children given the ketogenic diet because of seizures refractory to medication.
  
  
  METHODS
  In experiment I, breath acetone and plasma ketones were assessed every 2 h during an 8-h test day in seven children. In experiment II, a preliminary assessment of the possible relation between breath acetone and seizure frequency was made over 14 d in five children and one adolescent on the ketogenic diet.
  
  
  RESULTS
  Breath acetone was positively and curvilinearly related to plasma acetone (r2 = 0.99, P < 0.0001), plasma acetoacetate (r2 = 0.89, P < 0.0001), and plasma beta-hydroxybutyrate (r2 = 0.94, P < 0.0001). No significant relation was found between breath acetone and seizure frequency or change in seizure frequency.
  
  
  CONCLUSIONS
  Breath acetone is indicative of systemic ketosis while on the ketogenic diet. However, owing to the wide range of seizure types and plasma acetone, more subjects will be needed to determine whether there is a clear link between breath acetone and seizure frequency or decreased seizure frequency while on the high-fat ketogenic diet.
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Musa-Veloso
authors.forename: Sergei S
authors.initials: SS
authors.lastname: Likhodii
authors.forename: Exequiel
authors.initials: E
authors.lastname: Rarama
authors.forename: Stephanie
authors.initials: S
authors.lastname: Benoit
authors.forename: Yeou-Mei Christiana
authors.initials: YM
authors.lastname: Liu
authors.forename: Dominic
authors.initials: D
authors.lastname: Chartrand
authors.forename: Rosalind
authors.initials: R
authors.lastname: Curtis
authors.forename: Lionel
authors.initials: L
authors.lastname: Carmant
authors.forename: Anne
authors.initials: A
authors.lastname: Lortie
authors.forename: Felix J E
authors.initials: FJ
authors.lastname: Comeau
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Cunnane
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests / Q000379:methods*; D002648:Child; D002849:Chromatography, Gas; D004032:Diet; D004827:Epilepsy / Q000178:diet therapy* / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007657:Ketone Bodies / Q000032:analysis* / Q000096:biosynthesis; D007659:Ketones / Q000097:blood; D007662:Ketosis / Q000175:diagnosis*; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012640:Seizures / Q000178:diet therapy* / Q000453:epidemiology / Q000517:prevention & control; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D015415:Biomarkers; D007657:Ketone Bodies; D007659:Ketones