title: Ketogenic diet therapy for epilepsy during pregnancy: A case series.
abstract: OBJECTIVE
  Evaluation of ketogenic diet (KD) therapies for seizure control during pregnancy when safety and appropriate management become considerations. Until now, no information has been available on seizure reduction and human pregnancy related outcomes in women treated with KD therapies.
  
  
  METHODS
  We describe two cases of pregnant women with epilepsy treated with KD therapy either as monotherapy (Case 1) or as adjunctive therapy (Case 2).
  
  
  RESULTS
  Case 1: A 27 year old woman, gravida1, started the classic KD with medium chain triglyceride (MCT) emulsion and 75g carbohydrate-restriction, later reduced to 47g. Glucose levels were 4-6mmol/L and blood ketone levels ranged from 0.2 to 1.4mmol/L. Seizure frequency decreased and seizure-free days increased. Mild side effects included intolerance to MCT, reduced serum carnitine and vitamin levels, and mild hyperlipidemia. Fetal and neonatal growth was normal as was growth and development at 12 months. Case 2: A 36 year-old nulliparous woman was treated with a 20 gram carbohydrate-restricted Modified Atkins Diet (MAD) and lamotrigine, resulting in reduction of seizure frequency to once per month prior to pregnancy. Once pregnant, carbohydrates were increased to 30g. When seizures increased, lamotrigine dose was doubled. Urine ketones trended down during second trimester. A male was born with bilateral ear deformities of unknown significance. The child had a normal neurodevelopment at eight months.
  
  
  CONCLUSIONS
  Non-pharmacological epilepsy therapies like KD and MAD may be effective during human pregnancy. However, safety still has to be established. Further monitoring to identify potential long term side effects is warranted.
authors.affiliation: Department of Dietetics, Erasmus MC, Rotterdam, The Netherlands. Electronic address: e.vanderlouw@erasmusmc.nl.
authors.forename: Elles J T M
authors.initials: EJ
authors.lastname: van der Louw
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, USA. Electronic address: twill145@jhmi.edu.
authors.forename: Tanya J
authors.initials: TJ
authors.lastname: Williams
authors.affiliation: Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: bjhenry@jhu.edu.
authors.forename: Bobbie J
authors.initials: BJ
authors.lastname: Henry-Barron
authors.affiliation: Department of Dietetics, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Olieman
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Duvekot
authors.affiliation: Department of Pediatric Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Marijn J
authors.initials: MJ
authors.lastname: Vermeulen
authors.affiliation: Center of Lysosomal and Metabolic Diseases, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Natalja
authors.initials: N
authors.lastname: Bannink
authors.affiliation: Department of Pediatric Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Center of Lysosomal and Metabolic Diseases, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Williams
authors.affiliation: Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Rinze F
authors.initials: RF
authors.lastname: Neuteboom
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Suite 2158, Baltimore, MD, USA.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kossoff
authors.affiliation: Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Coriene E
authors.initials: CE
authors.lastname: Catsman-Berrevoets
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, USA.
authors.forename: Mackenzie C
authors.initials: MC
authors.lastname: Cervenka
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D055423:Diet, Ketogenic / Q000379:methods*; D004827:Epilepsy / Q000097:blood / Q000178:diet therapy*; D005260:Female; D006801:Humans; D007659:Ketones / Q000097:blood; D011247:Pregnancy
chemical_list: D001786:Blood Glucose; D007659:Ketones
keywords: Ketogenic diet; Ketosis; Modified Atkins Diet; Non-pharmacological; Pregnancy; Women