title: Valproic acid and phenobarbital blood levels during the first month of treatment with the ketogenic diet.
abstract: OBJECTIVE
  The aim of this study was to assess how the ketogenic diet influences the blood levels of antiepileptic drugs in the first month of treatment in a pediatric population with drug-resistant epilepsy.
  
  
  METHODS
  The plasma concentrations of antiepileptic drugs were investigated in an open study on 36 consecutive children and adolescents (20 males), aged between 6 months and 16 years (mean age 4.7 years), who were put on the ketogenic diet because of medically refractory epilepsy. The plasma levels of antiepileptic drugs were determined 30 days and immediately before the diet and on days 8, 15, 22 and 29 after the start of the diet. The daily dose of each drug was not changed during the first month of treatment, while the daily dose of benzodiazepines was reduced by up to 30% if excessive sedation or drowsiness occurred.
  
  
  RESULTS
  While plasma concentrations of phenobarbital did not change in the first month on the ketogenic diet (mean increase of 2.3 mg/l ± 1.0), valproic acid showed a slight but not significant decrease (mean decrease of 6.7 mg/l ± 3.2), 2 weeks after the start of the diet.
  
  
  CONCLUSIONS
  Adjustments in the daily dose of either drug before the start of the diet do not however appear to be justified.
authors.affiliation: Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples, Naples, Italy. giangennaro.coppola@unina2.it
authors.forename: G
authors.initials: G
authors.lastname: Coppola
authors.forename: A
authors.initials: A
authors.lastname: Verrotti
authors.forename: A
authors.initials: A
authors.lastname: D'Aniello
authors.forename: S
authors.initials: S
authors.lastname: Arcieri
authors.forename: F F
authors.initials: FF
authors.lastname: Operto
authors.forename: R
authors.initials: R
authors.lastname: Della Corte
authors.forename: E
authors.initials: E
authors.lastname: Ammendola
authors.forename: A
authors.initials: A
authors.lastname: Pascotto
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000097:blood / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D055423:Diet, Ketogenic; D004827:Epilepsy / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010634:Phenobarbital / Q000097:blood* / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014635:Valproic Acid / Q000097:blood* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid; D010634:Phenobarbital