Dieta ketogeniczna poprawia stabilność autonomicznego układu sercowego u dzieci z opornościową epilepsją: badanie zmienności rytmu serca w obserwacji długoterminowej

OBJECTIVE: Pediatric drug-resistant epilepsy(DRE) is frequently associated with autonomic dysregulation, which contributes to increased cardiovascular morbidity. This study evaluated the impact of a ketogenic diet(KD) therapy on cardiac autonomic regulation in children with DRE using heart rate variability(HRV) metrics. METHODS: In this prospective longitudinal observational study, 13 pediatric patients with DRE were enrolled.All patients underwent 24-hour ambulatory ECG (Holter) monitoring at baseline and after six months of ketosis.Time-domain HRV parameters (SDNN,SDANN,RMSSD, pNN50) and heart rate dynamics were analyzed. A blinded pediatric cardiologist performed a comprehensive arrhythmia analysis to ensure cardiac safety. RESULTS: Following six months of KD therapy, a statistically significant increase was observed in SDNN,rising from 105.77 ± 44.11 ms to 127.38 ± 37.70 ms(p=0.0479), indicating an enhancement in global autonomic tonus and homeostatic resilience. Additionally, the minimum heart rate exhibited a significant stabilization, increasing from 42.46 ± 27.07 bpm to 60.31 ± 26.20 bpm(p = 0.0314).Other HRV parameters showed upward numerical trends but did not reach statistical significance.No clinically significant arrhythmias or conduction abnormalities were detected, confirming a favorable cardiac safety profile. CONCLUSION: In this exploratory longitudinal study, ketogenic diet therapy was associated with selective improvements in cardiac autonomic parameters,particularly increased SDNN and minimum heart rate,in children with drug-resistant epilepsy.These findings provide preliminary evidence that ketosis may favorably influence autonomic regulation in this population. However, given the limited sample size and the absence of a control group,the results should be interpreted with caution and should not be considered definitive.More research is needed to confirm these observations and define the clinical value of HRV monitoring during ketogenic diet therapy.