Intractable Seizures in Children With Type 1 Diabetes: Implications of the Ketogenic Diet.

Introduction: The ketogenic diet is prescribed for seizures in some children with epilepsy. Children with type 1 diabetes are at risk for diabetic ketoacidosis caused by ketosis due to decreased insulin effect. Currently there are no clinical guidelines regarding the safety and efficacy of the ketogenic diet in patients with concurrent epilepsy and type 1 diabetes.

Objectives: This review examines the current literature regarding the association between TID and epilepsy, proposed mechanisms for the observed relationship, risks and benefits of the ketogenic diet, and clinical applications of the ketogenic diet in the context of type 1 diabetes and epilepsy.

Methods: PubMed was used to identify relevant articles. Key search terms included, "type 1 diabetes," "ketogenic diet," "seizure," "epilepsy," and "autoimmunity."

Results: There is an observed association between type 1 diabetes and epilepsy, with proposed mechanisms including genetic predisposition, anti-glutamic acid decarboxylase (GAD) antibodies, metabolic derangements and cerebrovascular damages. Case reports describe the use of the ketogenic diet for epilepsy management in children with diabetes with mixed results; however, there are no large, randomized controlled trials to evaluate the broader application of these findings.

Conclusions: In summary, there is inadequate evidence to support the use of the ketogenic diet in patients with coexisting epilepsy and type 1 diabetes in clinical practice. Further research is needed to determine the effectiveness, safety, and monitoring parameters of the ketogenic diet for these patients. The risks and benefits of the ketogenic diet as medical nutrition therapy for patients with both type 1 diabetes and epilepsy should be considered on an individualized basis.