Welcome to the first Keto News of 2015! Approximately one month ago I had the pleasure of attending the 2014 Annual Meeting of the American Epilepsy Society, which was held in Seattle, Washington, on December 5 to 9. Throughout the meeting there was a significant component of ketogenic diet research being presented.
The "SIG" (Special Interest Group) included two debates on whether the ketogenic diet was disease-modifying (truly "antiepileptic" versus just "anticonvulsant"): Dr. Detlev Boison vs. Dr. Timothy Simeone (basic science) and Dr. Sudha Kessler vs. Dr. Renee Shellhaas (clinical evidence). A platform presentation occurred on Monday, December 8th, regarding the use of diets in adults by Dr. Mackenzie Cervenka from our Hopkins team. This presentation has been highlighted in the press as well. (View press coverage on Medscape with a free log in.)
To me, however, the highlight of the conference has always been the ketogenic diet posters. Posters allow for researchers to communicate new information that has not yet been published and is potentially very exciting. The poster session also helps bring the researchers face-to-face with meeting attendees in an informal setting. I had the privilege of running a "poster tour" that brought a modest size group of attendees to visit six posters of particular importance. Here are brief summaries of these posters. (All of the meeting's abstracts are available here.)
AN EVALUATION OF CATAMENIAL SEIZURE PATTERNS AND THE RELATIONSHIP BETWEEN THE MENSTRUAL CYCLE, SEIZURES, AND KETOSIS IN WOMEN ON THE MODIFIED ATKINS DIET FOR TREATMENT FOR EPILEPSY. Authors: Elizabeth Felton, Eric Kossoff, Bobbie Henry and Mackenzie Cervenka
This study reviewed the experience on the Modified Atkins diet of 46 women. Interestingly, 4 of 5 women with detailed calendars had a change in their seizure patterns showing they became "catamenial" over time, meaning their seizures became associated with their menstrual periods.
PREDICTORS OF KETOGENIC DIET EFFICACY IN CHILDREN BASED ON THE ELECTROENCEPHALOGRAM. Authors: Ian Walker and Rana Said
This study, which has since been published in the Journal of Child Neurology, looked at 81 patients in Dallas on the ketogenic diet and whether their EEGs helped predict a seizure reduction. Surprisingly, a change in spikes (seizure discharges) did not correlate, but an improvement in the background slowing (sign of an underlying brain disturbance) did.
USE OF THE KETOGENIC DIET IN THE NEONATAL INTENSIVE CARE UNIT - SAFETY AND TOLERABILITY. Authors: Ara Hall, Megan Gustafson and Lindsey Thompson
Dr. Hall presented a small but very interesting case series of three infants from the ketogenic diet center in Kansas City, two of whom had a good response to the diet. Using the diet in this extremely young population had some drawbacks (including unfamiliarity with the diet by the nurses and physicians in the ICU), but it was definitely feasible. One child started the diet at 19 days of age.
EVALUATION OF PATIENTS' RIGHT AND LEFT VENTRICULAR FUNCTIONS WHO WERE TREATED WITH KETOGENIC DIET. Authors: Onder Dokgoz, Kubra Celegen, Orkide Guzel, U. Yilmaz, Rana Isgüder, Mehmet Celegen and Timur Mese
This prospective trial of 38 children on the ketogenic diet in Turkey found that after 6 months, the right ventricular heart function was somewhat impaired on the diet. Other aspects of heart function seemed fine, there were no symptoms in these children, and more research needs to be done to see if this is reversible. However, it does raise some concerns about cardiovascular health on the diet.
BLOOD BETA-HYDROXYBUTYRATE LEVELS CORRELATE WITH SEIZURE FREQUENCY IN EPILEPTIC PATIENTS TREATED WITH THE KETOGENIC DIET. Authors: Jeffrey Buchhalter, Jacklyn Smith, Sabrina D'Alfonso, Rachael Singer, Mary Connolly, Aspasia Michoulas, Ernest Fung, David Sinasac and Jong Rho
For many years, the subject about whether blood (or urine) ketones relate to seizure control has been debated. In this study from two centers in Canada, 27 children on the ketogenic diet had blood ketones followed at clinic visits. There seemed to be a correlation between decreasing seizures over the first 12 months and ketones (typically above 3 mMol/L range).
PRELIMINARY OVERVIEW OF SOCIAL STRESSORS AND SOCIAL WORK SUPPORT OF PATIENTS AND CAREGIVERS IN THE KETOGENIC DIET PROGRAM AT BOSTON CHILDREN'S HOSPITAL. Authors: Chris Ryan, Foley Chris, Karen Costas, Stacey Tarrant, Pixley Lora, Phillip Pearl and Ann Bergin
In this poster from Boston Children's Hospital, the researchers surveyed their experience in treating 124 children with the ketogenic diet where social workers were able to be involved in their care. There were many stressors to families, but the two highest (financial barriers and parental stress/divorce) were not necessarily unique to the ketogenic diet. This raises an important point about the value of getting help from hospital resources prior to starting the diet.