Abstracts

Rationale: Some anti-seizure medications (ASMs) are known to induce liver enzymes and thereby negatively impact lipid values including total cholesterol (TC), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglyceride (TG). In addition, use of ketogenic diet therapies (KDTs) has also been shown to influence lipids. Here, we explored the combined impact of enzyme inducing ASMs (EIASMs) and KDT on lipid values in adults with epilepsy who began a KDT.

Methods: Diet-naïve adults with epilepsy who presented to the Adult Epilepsy Diet Center to begin a KDT were divided into three groups based on the ASMs they were taking: EIASMs, non-EIASMs, and those on no ASMs.  Demographic information (including gender, age, race, weight, physical activity level, history of smoking, hyperlipidemia, and diabetes mellitus), epilepsy-specific clinical history (including epilepsy type and total number of ASMs at presentation and previously tried), and lipid values (fasting serum levels of TC, LDL, HDL, TG, and non-HDL) were obtained through retrospective chart review at baseline and twelve months.

Results: Of 231 diet-naive adults with epilepsy receiving instruction on beginning a KDT, 29 did not begin KDT and 111 did not have 12-month follow up, leaving 91 study participants. Of these, 42 participants had baseline and follow up lipid levels measured. There was no significant difference in demographic variables between study completers and those who did not follow up. There was a significant increase in median TC level (Baseline 191 (57) mg/dL, 12-month 218 (61) mg/dL; Z = -3.357, p < 0.001), LDL (109 (47) mg/dL, 131 (53), mg/dL; Z = -2.799, p = 0.005 ), non-HDL (123 (59) mg/dL, 146 (57) mg/dL; Z = -2.480, p = 0.013), and HDL (55 (21) mg/dL, 66 (28) mg/dL, Z = -4.176, p < 0.001) at 12 months compared to baseline in adults who began a KDT. When separated according to ASM category, adults on a KDT and non-EIASMs also showed significant elevations in cholesterol (177 (39) mg/dL, 206 (48) mg/dL; Z = -2.029, p = 0.042), HDL (56 (18) mg/dL, 66 (20) mg/dL; Z = -2.434, p = 0.015), and LDL (108 (27) mg/dL, 125 (50) mg/dL; Z = -2.068, p = 0.039) at 12 months compared to baseline. In contrast, adults on a KDT and EIASMs only showed a significant increase in HDL at 12 months compared to baseline (51 (30) mg/dL, 66 (40) mg/dL; Z =-3.313, p = < 0.001). Although sample size was limited (N=5), adults on a KDT and no ASMs did not show significant differences at 12 months compared to baseline but a trend was observed for an increase in cholesterol, HDL, LDL, and non-HDL levels.