By Eric Kossoff, MD

Happy New Year! As 2008 begins, we look back on an exciting year for research in the ketogenic diet. The year 2007 brought many new articles into the medical literature that helped change the way we use the ketogenic diet. There were over 80 articles published in 2007 – a new record. Here are the top 10 articles according to this author (in no particular order).

• 1. "Safe and Effective Use of the Ketogenic Diet in Children with Epilepsy and Mitochondrial Respiratory Chain Complex Defects" by Kang, et al from South Korea (1). In this study, the worries about the use of the diet for children with mitochondrial disorders, claimed for years, is brought into question. Fourteen children were treated, 7 became seizure-free. The diet was safe in these children as well.
• 2. “A Prospective Study of the Modified Atkins Diet for Intractable Epilepsy in Adults” by Kossoff et al. from Baltimore (2). This study, which was discussed in the March issue of KetoNews http://www.epilepsy.com/epilepsy/keto_news_march07 showed that dietary therapies can be successfully used in adults. The good news was that they worked and worked quickly. The bad news was that it was still tough. Many adults stopped the diet even if when it was helping because it was so restrictive.
• 3. “Current treatment of myoclonic astatic epilepsy: clinical experience at the Children's Hospital of Philadelphia” by Kilaru and Bergqvist from Philadelphia (3). Although this article does not specifically include the ketogenic diet in the title, the diet was key to the conclusion -- children with this condition, otherwise known as Doose syndrome, responded very well to the ketogenic diet and were in fact the most likely to become seizure-free using it. This confirms what many neurologists are beginning to realize: for myoclonic-astatic epilepsy, the ketogenic diet may be the most effective therapy.
• 4. “Kidney stones and the ketogenic diet: risk factors and prevention” by Sampath, et al. from Baltimore (4). In this article, the authors found that the use of Polycitra K reduced the risk of kidney stones by three-fold. Kidney stones are one of the most common side effects of the ketogenic diet. They suggested that its empiric use might be worthwhile for all patients.
• 5. “Children with seizures exhibit preferences for foods compatible with the ketogenic diet” by Amari, et al. from Baltimore (5). http://www.epilepsy.com/epilepsy/keto_news_september07 .This article was highlighted in the September issue of KetoNews and discusses the surprising finding that children with epilepsy preferred high fat foods when compared to controls.
• 6. “Ketogenic diet metabolites reduce firing in central neurons by opening K(ATP) channels” by Ma et al. from Boston (6). This article, which was highlighted in a basic science review in the October issue of KetoNews, discusses a novel potential mechanism of action of the ketogenic diet, potassium channels in the brain.
• 7. “The calorically restricted ketogenic diet, an effective alternative therapy for malignant brain cancer” by Zhou et al, Boston (7). This article discusses the results of using the ketogenic diet in a population of adult mice given malignant brain tumors. The ketogenic diet appeared to decrease the growth rate of these tumors. Attention from this article, although not in humans, led to a feature in Time magazine: http://www.time.com/time/health/article/0,8599,1662484,00.html
• 8. “Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy” by Stainman et al. from Baltimore (8). Not all news about the ketogenic diet this year was good. In this article, the researchers found that the ketogenic diet was significantly less likely to result in either a >90% or seizure-free outcome in children who had partial epilepsy possibly amenable to epilepsy surgery. In those children, surgery achieved those goals.
• 9. “When do seizures usually improve with the ketogenic diet?” by Kossoff et. al. (9). In this multicenter study, the groups in Baltimore and Chicago teamed up to evaluate when, according to seizure calendars, children started on the ketogenic diet tended to have their improvement occur. The results were surprising: a median of 5 days! The diet worked more quickly (5 vs. 14 days) in those fasted. In addition, if the diet did not work by 60 days, it was not likely to occur ever (in this group).
• 10. “Predictive Power of First Morning Glucose and the Ketogenic Diet” by Bergqvist et al. from Philadelphia (10). In this paper just published in December, the authors attempted to analyze whether serum glucose during the first 21 days of the ketogenic diet use impacted efficacy. This is a hot topic as some researchers believe glucose, not ketones, are more important for efficacy. At least in this study, glucose did not appear important.

• 1. Kang HC, Lee HS, You SJ, Kang du C, Ko TS, Kim HD. Use of a modified Atkins diet in intractable childhood epilepsy. Epilepsia. 2007 Jan;48(1):182-6.
• 2. Kossoff EH, Rowley H, Sinha SR, Vining EP. A prospective study of the modified Atkins diet for intractable epilepsy in adults. Epilepsia. 2007 Oct 5; [Epub ahead of print].
• 3. Kilaru S, Bergqvist AG. Current treatment of myoclonic astatic epilepsy: clinical experience at the Children's Hospital of Philadelphia. Epilepsia. 2007 Sep;48(9):1703-7.
• 4. Sampath A, Kossoff EH, Furth SL, Pyzik PL, Vining EP. Kidney stones and the ketogenic diet: risk factors and prevention. J Child Neurol. 2007 Apr;22(4):375-8.
• 5. Amari A, Dahlquist L, Kossoff EH, Vining EP, Trescher WH, Slifer KJ. Children with seizures exhibit preferences for foods compatible with the ketogenic diet. Epilepsy Behav. 2007 Aug;11(1):98-104.
• 6. Ma W, Berg J, Yellen G. Ketogenic diet metabolites reduce firing in central neurons by opening K(ATP) channels. J Neurosci. 2007 Apr 4;27(14):3618-25.
• 7. Zhou W, Mukherjee P, Kiebish MA, Markis WT, Mantis JG, Seyfried TN. The calorically restricted ketogenic diet, an effective alternative therapy for malignant brain cancer. Nutr Metab (Lond). 2007 Feb 21;4:5.
• 8. Stainman RS, Turner Z, Rubenstein JE, Kossoff EH. Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy. Seizure. 2007 Oct;16(7):615-9.
• 9. Kossoff EH, Laux LC, Blackford R, Morrison PF, Pyzik PL, Hamdy RM, Turner Z, Nordli DR Jr. When do seizures usually improve with the ketogenic diet? Epilepsia. 2007 Nov 19; [Epub ahead of print]
• 10. Bergqvist AG, Schall JI, Richard EL, Gallagher PR, Stallings VA. Predictive power of first morning glucose and the ketogenic diet. Neuropediatrics. 2007 Aug;38(4):193-6.

Edited by Steven C. Schachter, MD