The Effect of Carnitine Supplementation on Cardiac Function and Ketogenic Diet Effectiveness in Patients with Drug Resistant Epilepsy on Ketogenic Diet

Abstract Background Ketogenic Diet (KD) is gaining attention as a management line in childhood drug resistant epilepsy (DRE) and it is an effective line of therapy for DRE in children. KD is a strict diet consisting of minimal carbohydrate and adequate protein intake with increased fat content. Although KD is effective for epilepsy management, it is deficient in several minerals, vitamins, and trace elements, which can lead to several early and late complications. Objective To demonstrate the effect of carnitine supplementation on cardiovascular functions in patients with DRE on KD and to highlight the effect of carnitine supplementation on efficacy of KD in seizure control. Methods This study was a clinical trial (Trial Design: Parallel 1:1) which included 52 patients with DRE on KD following up at Pediatric Neurology and Clinical Nutrition Outpatient Clinics at Ain Shams University children`s Hospital (or admitted as inpatient) in the period from March 2022 to October 2022 Results There was a statistically significant decrease in the CSSS after 6 months compared to initial presentation among the L-carnitine supplemented group. After 6 months of L-carnitine supplementation, the supplemented group showed significant increase in interventricular wall thickness diameter (IVSD) and significant increase in posterior wall thickness (PWT). Left ventricular end-diastolic diameter (LVED) and left ventricular (LV) mass index showed also increased but didn’t reach significance statistically after L- carnitine supplements. There was no statistically significant difference between carotid intima-media thickness CIMT at initial presentation and after 6 months among L-carnitine supplemented group. Conclusion After six months of L-carnitine supplementation in patients with DRE on KD, there was improvement in the frequency and duration of convulsions among L-carnitine group. Regarding ECHO finding, L-carnitine group showed increase in interventricular wall thickness diameter (IVSD) and posterior wall thickness (PWT). Left ventricular end-diastolic diameter (LVED) and left ventricular (LV) mass index also showed increases but didn’t reach statistical significance after L- carnitine supplementation. There was no statistically significant difference in carotid intima-media thickness CIMT at initial presentation and after 6 months among L-carnitine supplemented group.