[Research] Ketogenic diet appears to be less effective combined with Lamotrigine

[Dutch mom]

Recent research about the effectiveness of the keto diet when using Lamictal was done by my son's dietitian (Van der Louw) and his neurologist (Neuteboom) from the Erasmus medical Center (Sophia Children's Hospital) in Rotterdam, The Netherlands.

Seizure. 2015 Nov;32:75-7. doi: 10.1016/j.seizure.2015.09.007. Epub 2015 Sep 21.

Concomitant lamotrigine use is associated with decreased efficacy of the ketogenic diet in childhood refractory epilepsy.

Author information

van der Louw EJ1, Desadien R2, Vehmeijer FO2, van der Sijs H3, Catsman-Berrevoets CE2, Neuteboom RF2.

Abstract

PURPOSE:

Anti-epileptic drugs (AEDs) and the ketogenic diet (KD) are often used concomitantly in children with refractory epilepsy. It has been hypothesised that certain AEDs may interfere with KD. The purpose of this study was to elucidate relationships between efficacy of KD and use of specific AEDs.

METHODS:
A retrospective study was performed in 71 children with refractory epilepsy starting the KD between 2008 and 2014 in Erasmus University Hospital Sophia Children's Hospital. Efficacy of the KD (defined as 50% seizure reduction) was evaluated after three months of treatment and related to the AEDs used.

RESULTS:
The KD was successful after three months in 61% of the children (N=71). Efficacy was significantly reduced if children (n=16) used lamotrigine (31%) at diet initiation or in the course of the diet, compared to other antiepileptic drugs (69%) (p=0.006). In comparison to children using other antiepileptic drugs, the percentage of children that had adequate ketosis was significantly reduced in case of lamotrigine use (p=0.049).

CONCLUSION:
Lamotrigine treatment during KD is associated with a decreased efficacy of the KD.

Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

 

[Nakamova]

Thanks DM, that's fascinating to hear. I wonder what it is about Lamotrigine that detracts from the diet. Did the study have any theories?

 

[Dutch mom]

I don't know Nak, I just read the abstract. I will ask the dietitian as soon as I meet her again.

 

[epileric]

This article on the study says:

The authors give several possible explanations for these findings including the induction of UDP glucuronosyltransferase 1 family, polypeptide A6 (UGT1A6) enzyme activity by the Ketogenic diet which increased the glucuronidation of lamotrigine to its inactive metabolites, the interaction between ketones and lamotrigine on glutamate neurotransmitter release or lamotrigine specifically interfering with the formation of ketones. The current study by van der LouW et al highlights the implications on lamotrigine use alongside ketogenic diet and suggest that levels of lamotrigine and its metabolites should be measured, and doses adjust or treatment discontinued if adequate ketone levels are not achieved.

http://ftp.icnapedia.org/journal-watch/concomitant-lamotrigine-use-is-associated-with-decreased-efficacy-of-the-ketogenic-diet-in-childhood-refractory-epilepsy

I know, it's not very definitive.

 

[AlohaBird]

To me the cool side effect of this study is that, when you take out the Lamictal users, the stats on the keto diet get even more impressive.