Breath acetone predicts plasma ketone bodies in children with epilepsy on a ketogenic diet.
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.
Musa-Veloso
Kathy
K
Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Likhodii
Sergei S
SS
Rarama
Exequiel
E
Benoit
Stephanie
S
Liu
Yeou-Mei Christiana
YM
Chartrand
Dominic
D
Curtis
Rosalind
R
Carmant
Lionel
L
Lortie
Anne
A
Comeau
Felix J E
FJ
Cunnane
Stephen C
SC
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
D000927:Anticonvulsants; D015415:Biomarkers; D007657:Ketone Bodies; D007659:Ketones