Effects of the ketogenic diet on platelet counts and global coagulation tests in childhood epilepsy

Abstract

Several antiseizure drugs (ASD), especially Valproic acid (VPA), influence platelet counts and coagulation parameters. The ketogenic diet (KD), established in drug-resistant epilepsy, is combined with ASDs. Bruising and prolonged bleeding times during KD have been described, but whether hemostatic changes result from the KD or from concomitant ASDs, remains unclear. Aim of the present study was to evaluate bleeding, platelet counts and global coagulation tests prior to and during KD in childhood epilepsy. Method: Consecutive children treated with KD were systematically observed for bleeding. Serial measurements of platelet counts and global coagulation tests (APTT, PT and fibrinogen) were obtained at baseline and during KD (at 1, 3, 6 and 12 months). Children with KD monotherapy, concomitant VPA, or other ASDs were compared. Results: Among 162 children receiving KD, we observed neither bleeding in daily life nor perioperative bleeding in those undergoing surgery (n = 25). Most children had normal platelet counts and coagulation parameters. Only a few had transient mild thrombocytopenia and mildly prolonged APTT values, not indicative of a bleeding risk. Even KD combined with VPA did not cause relevant coagulopathy. Unexpectedly, we found mild thrombocytosis in 24 % of patients prior to KD, which was most pronounced in yet untreated epilepsy. Thrombocytosis steadily resolved during KD. Conclusions: During KD treatment of childhood epilepsy, we observed neither bleeding symptoms nor laboratory results indicating a bleeding risk. Unexpectedly, mild thrombocytosis was present in 24 % at baseline, normalising during KD. Thrombocytosis may reflect the underlying inflammatory process of untreated epilepsy and requires further study.

A Review of the Multi-Systemic Complications of a Ketogenic Diet in Children and Infants with Epilepsy

“…Further study of six patients revealed increased bleeding time and diminished platelet reactivity to aggregating factors, suggesting altered membrane dynamics secondary to lipid changes [ 66 ]. However, a more recent study of 162 children on a KD for epilepsy found no differences in platelet counts or function after one year on the KD [ 68 ]. In this study, it was also shown that desmopressin was able to stimulate clotting in vitro, suggesting a possible treatment for patients with concerning bruising [ 66 ].…”

Craniotomy Complicated by Severe Metabolic Acidosis Requiring Massive Transfusion in an Infant on Ketogenic Diet Therapy for Intractable Epilepsy

“…However, Dressler et al noted no coagulation abnormalities in a consecutive series of 162 children receiving the KD. 18 Serial measurements of platelet counts and global coagulation tests (aPTT, PT, and fibrinogen) were obtained at baseline and during KD therapy (at 1, 3, 6 and 12 months). The authors noted no clinical bleeding either during routine activities of daily life or during surgery and no clinically significant abnormalities in coagulation function; however, platelet function was not assessed.…”

"Dietary Factors Influencing Platelet Counts: Knowledge to Improve Concentration for Platelet-Rich Plasma Injections"

“…Al revealed mild thrombocytosis in epileptic pediatric patients at baseline which subsequently normalized while on a ketogenic diet in all patient groups within 6 months. The baseline elevation in platelet count in the epileptic population is thought to be due to underlying inflammation [32]. The ketogenic diet has been shown to have anti-inflammatory properties by reducing IL-8 Beta levels in the brain and plasma [33].…”