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Monday, March 15, 2010

As has been increasingly the case, the American Epilepsy Society Annual Meeting continues to be the event each year in which new scientific information regarding the use of dietary treatments in epilepsy is made available. Regularly scheduled “keto” events include the 90-minute ketogenic diet Special Interest Group meeting, along with the board meeting of the Charlie Foundation. There are also several poster and platform presentations each year devoted to the ketogenic diet. What were some of the highlights at this year’s meeting in Boston, which occurred December 4-8, 2009?

The annual Ketogenic Diet Special Interest Group was held on Tuesday December 8th. Following on the success of ketogenic “debates” 2 years ago, I arranged two more debates this year. First, Dr. Stephané Auvin from Paris France and Dr. Carl Stafstrom from Madison, Wisconsin discussed their theories on a basic science level for why the ketogenic diet is primarily effective. Dr. Auvin argued that the high fat nature of the diet was critical, whereas Dr. Stafstrom presented information on how the low glucose levels induced by the diet may actually be more important. Both investigators agreed that the diet was complex and for certain conditions one possible mechanism may be more important than the other. Second, Dr. Elizabeth Donner from Toronto Canada argued that the ketogenic diet was so effective (and relatively free of side effects) that it should be used much earlier in the course of epilepsy, perhaps even first-line. This has been discussed in a KetoNews article previously. Dr. Douglas Nordli from Chicago, Illinois agreed that the diet should be used sooner, but not first. He argued that other than for GLUT-1 (glucose transporter 1) deficiency and pyruvate dehydrogenase deficiency, there is not enough scientific evidence to support this position. Several audience members participated significantly in this latter discussion, mentioning the logistical and financial dietitian drawbacks to first-line use of the diet. Information from our special interest group was highlighted recently in a Medscape article. Next year, Dr. Jong Rho and Dr. Elizabeth Thiele will take over the organization of the ketogenic diet Special Interest Group.

The ketogenic diet was mentioned favorably in other presentations at the AES meeting, including the “Clinical Roundtable” Special Interest Group chaired by Dr. Kevin Chapman on Saturday December 6th. The topic of discussion was the optimal treatment for infantile spasms, with Dr.Tallie Baram discussing corticosteroids, Dr. Carter Snead commenting on vigabatrin, and I presented evidence for the ketogenic diet. All three therapies clearly have a role in the treatment of this problematic form of epilepsy. Information the use of the ketogenic diet for infantile spasms (as a first-line treatment) has been previously discussed in KetoNews.

Poster presentations were plentiful at this year’s AES meeting, perhaps the most ever presented at this conference before to my knowledge. Nineteen posters presented information about using dietary treatments in epilepsy. Some of the highlights included:

  • Results from a prospective study of the modified Atkins diet in adults in Toronto by Smith et. al. 18 adults were treated but compliance was problematic and only 6 had seizure reduction.
  • Dr. Kang and his group from Korea randomized children who became seizure-free with the ketogenic diet for infantile spasms to either stop the diet after 6 months (16 children) or 2 years (24 children). There was no difference between groups, challenging the thought that the ketogenic diet must be continued for at least 2 years of total seizure freedom before discontinuation (at least for infantile spasms).
  • Dr. Wilfong and his group from Houston Texas confirmed our center’s previous findings in their 12 children that using a formula-only ketogenic diet led to less incidence of dyslipidemia (www.epilepsy.com/article/2009/7/ketogenic-diet-bottle)
  • Two similar studies from Dallas Texas (Dr. Said) and Norway (Dr. Bjurulf) described the challenges in starting a ketogenic diet center, with improvements over time largely a result of increasing dietitian confidence, managing adverse effects adequately, and maintaining children on the diet for at least several months (rather than giving up prematurely).
  • Information was provided by our group both as a poster and during the “Pediatric Epilepsy Highlights Session” as a platform presentation regarding the long-term effects of the ketogenic diet, years after it has been discontinued. As was expected (but never proven previously!), the ketogenic diet appears to have long-term beneficial effects on seizures without clear and persistent side effects. Information on this important paper was highlighted recently when it was published online in the journal Epilepsia in February and I will devote the next issue of KetoNews specifically to this research.

The next AES meeting will be held in San Antonio, Texas in December 2010. I look forward to sharing exciting information from that meeting with you afterwards!

Authored by: Eric Kossoff, MD on 3/2010
Reviewed by: Robert Fisher MD PhD on 3/2010
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