Valproate effect on ketosis in children under ketogenic diet.
BACKGROUND
Although ketogenic diet has been proven useful in the management of intractable seizures, interactions with other medicines have been reported. This study reports two patients on co-administration with ketogenic diet and valproate appearing undesirable side effects after increase or decrease of valproate pharmaceutical levels.


METHODS
Totally 75 patients suffering from drug-resistant epilepsy were treated with ketogenic diet in our departments. Their age varied from 6 months to 9 years. All patients were followed for at least 12 months and up to five years. Clinical and laboratory variables have been regularly assessed.


RESULTS
In 75 patients treated with ketogenic diet and valproate at the same time treatment was well tolerated. Two patients presented mild to moderate undesirable effects. In these patients the removal of valproate treatment resulted in an increase of ketosis with respective clinical signs. The conversion of the diet from 4:1 to 1:1 and 2,5:1 respectively resulted in reduction of ketosis and clinical improvement.


CONCLUSIONS
In the majority of cases co-administration of valproate and ketogenic diet seems to be safe. In two cases, valproate appeared to have a negative effect on ketosis (and weaning it led to over-ketosis). This interaction is worthy of future study.
1st Department of Neurology, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece; 2nd Department of Pediatrics, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece.
Martha
M
Spilioti
1st Department of Neurology, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece; 2nd Department of Pediatrics, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece.
Evangelos
E
Pavlou
4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece. Electronic address: mariaangogou@gmail.com.
Maria
M
Gogou
4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
Irene
I
Katsanika
4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
Efimia
E
Papadopoulou-Alataki
4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
Olga
O
Grafakou
1st Department of Neurology, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece; 2nd Department of Pediatrics, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece.
Anastasia
A
Gkampeta
3rd Department of Pediatrics, University of Athens, Attikon Hospital, Athens, Greece.
Argyrios
A
Dinopoulos
4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
Athanasios
A
Evangeliou
D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000009:adverse effects; D055423:Diet, Ketogenic; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D007662:Ketosis / Q000139:chemically induced / Q000178:diet therapy* / Q000188:drug therapy*; D008297:Male; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use*
D000927:Anticonvulsants; D014635:Valproic Acid
Children; Epilepsy; Ketogenic diet; Side-effects; Valproate