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European Archives of Paediatric Dentistry

, Volume 9, Issue 3, pp 148–152 | Cite as

Scurvy in child with epilepsy on a ketogenic diet with oral complications

  • N. S. Willmott
  • R. A. E. Bryan
Case report

Abstract

Background: Epilepsy is a symptom of cerebral dysfunction, where there is a sudden and disorganised discharge of electrical activity from a group of neurones, producing symptoms that range from sensory absences to convulsive movements and unconsciousness. Fasting is recognised as reducing the frequency of epileptic seizures in difficult-to-control patients. The ketogenic diet is a high fat, low carbohydrate and adequate protein diet that mimics the biochemical effects of fasting. It is deficient in some essential elements that require supplementation. Case report: A 9-year old girl with learning difficulties, developmental delay and refractory epilepsy was placed on the ketogenic diet in 2003. Prior to starting the diet she had had as many as 12 tonic seizures/day, with prolonged periods of non-convulsive status epilepticus. Subsequent to being placed on the diet, the frequency of her seizures reduced markedly; there were long periods during which she had none. In late 2006, the patient inhaled a primary molar. This was retrieved by emergency bronchoscopy and at the same time the remaining primary teeth were extracted. Three weeks later she was admitted to hospital with low-grade fever, persistently bleeding sockets, oedema of her hands and feet, a petechial rash and bruising. A differential diagnosis included: liver disease, bleeding dyscrasia, oncological pathology or scurvy. The most striking finding amongst a number of investigations was a vitamin C level of 0.7μmol/l (Deficiency: <11μmol/l). Accordingly a diagnosis of scurvy was made. Treatment: The patient was prescribed ascorbic acid 500mg twice/day. Three weeks later the patient’s vitamin C level was 141.5μmol/l; the dose was therefore reduced to 250mg once/day. Follow-up: At two-month review, the signs and symptoms of scurvy had resolved. Conclusion: Inhaling a tooth and scurvy are both rare occurrences. Paediatric dentists should be aware of the possible implications of a ketogenic diet.

Key words

Aspiration Epilepsy Ketogenic diet Scurvy 

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References

  1. Ballaban-Gil K, Callahan C, O’Dell C, et al. Complications of the ketogenic diet. Epilepsia 1998; 39:744–748.PubMedCrossRefGoogle Scholar
  2. Bough K J, Rho J M. Anticonvulsant mechanisms of the ketogenic diet. Epilepsia 2007; 48:43–58.PubMedCrossRefGoogle Scholar
  3. Carpenter K J. The history of scurvy and Vitamin C. Cambridge: Cambridge University Press, 1986.Google Scholar
  4. Fieselmann J F, Zavala D C, Keim L W. Removal of foreign bodies (two teeth) by fiberoptic bronchoscopy. Chest 1977; 72:241–243.PubMedCrossRefGoogle Scholar
  5. Freeman J M, Vining E P, Pillas D J, et al. The efficacy of the ketogenic diet — 1998: A prospective evaluation of intervention in 150 children. Pediatrics 1998; 102:1358–1363.PubMedCrossRefGoogle Scholar
  6. Furth S L, Casey J C, Pyzik P L, et al. Risk factors for urolithiasis in children on the ketogenic diet. Pediatr Nephrol 2000; 15:125–128.PubMedCrossRefGoogle Scholar
  7. Ghatak N R, Santoso R A, McKinney W M. Cerebellar degeneration following long-term phenytoin therapy. Neurology 1976; 26:818–820.PubMedCrossRefGoogle Scholar
  8. Hahn T J. Bone complications of anticonvulsants. Drugs 1976; 12:201–211.PubMedCrossRefGoogle Scholar
  9. Hahn T J, Halstead L R, De Vivo D C. Disordered mineral metabolism produced by kertogenic diet therapy. Calcif Tissue Int 1979; 28:17–22.PubMedCrossRefGoogle Scholar
  10. Hart R G, Easton J D. Carbamazepine and hematologic monitoring. Ann Neurol 1982; 11:309–312.PubMedCrossRefGoogle Scholar
  11. Henderson C E, Filloux F M, Alder S C, Lyon J L, Caplin D A. Efficacy of the ketogenic diet as a treatment option for epilepsy: Meta-analysis. J Child Neurol 2006; 21:193–198.PubMedGoogle Scholar
  12. Herzberg G Z, Fivush B A, Kinsman S L, Gearhart J P. Urolithiasis associated with the ketogenic diet. J Pediatr 1990; 117:743–745.PubMedCrossRefGoogle Scholar
  13. Katz R. Issues in clinical trial design from the FDA perspective. Epilepsia 2003; 44:9–15.PubMedCrossRefGoogle Scholar
  14. Keene D L. A systematic review of the use of the ketogenic diet in childhood epilepsy. Pediatr Neurol 2006; 35:1–5.PubMedCrossRefGoogle Scholar
  15. Kwiterovich P O jr., Vining E P, Pyzik P, Skolasky R jr., Freeman J M. Effect of a high-fat ketogenic diet on the plasma level of lipids, lipoproteins, and apolipoproteins in children. J Am Med Assoc 2003; 290:912–920.CrossRefGoogle Scholar
  16. Levy R, Cooper P. Ketogenic diet for epilepsy. Cochrane database of systematic reviews 2003, issue no.3.Google Scholar
  17. Ludemann J.P., Hughes C.A., Holinger L.D.: Management of foreign bodies of the airway; in: Shields T.W., LoCicero J., Ponn R.B. (eds): General thoracic surgery. 5th ed. Philadelphia: Lippencott Williams and Wilkens; 2000. pp 853–861.Google Scholar
  18. Mackay M T, Bicknell-Royle J, Nation J, Humphrey M, Harvey A S. The ketogenic diet in refractory childhood epilepsy. J Paediatr Child health 2005; 41:353–357.PubMedCrossRefGoogle Scholar
  19. Merritt H H, Putnam T J. Sodium diphenyl hydantoin in the treatment of convulsive disorders. J Am Med Assoc 1938; 111:1068–1073.CrossRefGoogle Scholar
  20. Pellock J.M. Utilization of new antiepileptic drugs in Children. Epilepsia 1996; 37:Supplement 1 566–573.CrossRefGoogle Scholar
  21. Rosenfeld W E, Sachdeo R C, Faught R E, Privitera M. Long-term experience with topiramate as adjunctive therapy and as monotherapy in patients with partial onset seizures: retrospective survey of open-label treatment. Epilepsia 1997; 38:Supplement 1 534–536.CrossRefGoogle Scholar
  22. Schwartz R H, Eaton J, Bower B D, Aynsley-Green A. Ketogenic diets in the treatment of epilepsy: short term clinical effects. Dev Med Child Neurol 1989; 31:145–51.PubMedCrossRefGoogle Scholar
  23. Selhorst J B, Kaufman B, Horwitz S J. Diphenylhydantoin-induced cerebellar degeneration. Arch Neurol 1972; 27:453–455.PubMedCrossRefGoogle Scholar
  24. Stewart W A, Gordon K, Camfield P. Acute pancreatitis causing death in a child on the ketogenic diet. J Child Neurol 2001; 16:682.PubMedCrossRefGoogle Scholar
  25. Tal-Or E, Schwartz Y, Bloom Y, et al. Aspirated tooth removal from airway through tracheotomy and flexible bronchoscopy. J Trauma 1996; 40:1029–1030.PubMedCrossRefGoogle Scholar
  26. Thiele E A. Assessing the efficacy of antiepileptic treatments. The ketogenic diet. Epilepsia 2003; 44:26–29.CrossRefGoogle Scholar
  27. Vining E.P.G. Freeman J.M. A multi-center study of the efficacy of the ketogenic diet. Arch Neurol 1998; 55:1433–1437.PubMedCrossRefGoogle Scholar
  28. Wheless J W. The ketogenic diet: Fa(c)t or fiction. J Child Neurol 1995; 10:419–423.PubMedCrossRefGoogle Scholar
  29. Woody R C, Steele R W, Knapple W L, Pilkington N S. Impaired neutrophil function in children with seizures treated with the ketogenic diet. J Pediatr 1989; 115:427–430.PubMedCrossRefGoogle Scholar

Copyright information

© Adis International 2008

Authors and Affiliations

  1. 1.Dept. Paediatric DentistryLeeds Dental InstituteLeedsEngland

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