Effects of L-Carnitine Supplementation on Gastric Emptying in Children with Drug Resistant Epilepsy on Ketogenic Diet

Abstract Background The ketogenic diet (KD) is a high fat, low carbohydrate, and adequate protein (1 g/kg) diet with a demonstrated efficacy in the treatment of drug-resistant epilepsy (DRE) in infants and children. Gastrointestinal (GI) disturbances are often related to scarce tolerance of the diet that results in a significant resistance to the ketogenic diet and even blunting its efficacy. In addition, ketogenic diet’s high-fat content prolongs the gastric emptying time thus favoring gastro-esophageal reflux disease, nausea and vomiting. Objectives The objective of the study was to assess the effect KD on Chalfont seizure severity scale and the effect of L-carnitine supplementation on gastric emptying in children with drug resistant epilepsy (DRE) on ketogenic diet (KD). Patients and Methods This was a randomized controlled clinical trial that was conducted on thirty children newly diagnosed with DRE. The patients were divided randomly into 2 groups (15 patients received KD with L-carnitine supplementation and the rest received KD only). Patients were assessed at baseline and 3 months of starting KD. Assessments of children included Chalfont Seizures Severity Scale and the antral length by ultrasound. Results The mean age of the studied children was 4.5 years in KD with L-carnitine supplementation group and 3.5 years in KD only group, 33.35% of the children were females and 66.65% were males. Our study showed that there was a highly significant increase in weight and height/length for age z-scores in all patients after intervention with p-value=0.002. Our results also showed marked improvement of seizures activity for epileptic children in both groups after 3 months of intervention. Our study proved that the patients who received KD with L-carnitine supplementation showed highly significant increase in HDL level after intervention. A comparison between the two studied groups regarding the antral length by ultrasound showed that there was no statistically significant difference between both groups at time of enrolment and after intervention. Conclusion KD is an effective, safe, and tolerable therapy for children with DRE. Although antral length didn’t reach statistically significant difference between both groups initially and after KD therapy, L- carnitine supplementation had a positive effect on fasting lipid profile.