by Elaine Wirrell, MD
The ketogenic diet can be a highly effective therapy for epilepsy. On the ketogenic diet, the body burns fats rather than sugar, which results in the production of ketones.
In the early 20th century, reports emerged that described fasting as a seizure treatment for some children. While fasting controlled seizures in many cases, prolonged fasting was clearly not a viable long-term solution. In 1925, Dr. Peterman at the Mayo Clinic reported on the successful use of a “ketogenic diet,” which was designed to mimic the fasting state and provide adequate calories for growth and development. The ketogenic diet was used in only a few centers over most of the 20th century. However, in the last two decades, there has been a marked resurgence of interest in its use. The ketogenic diet is now available in most epilepsy centers. (See the list of centers at www.charliefoundation.org.)
Who Can Be Treated?
The ketogenic diet is used most often in children with epileptic encephalopathies such as Lennox-Gastaut syndrome, Dravet syndrome, Myoclonic-Atonic Epilepsy of Doose and West syndrome. These particular syndromes often result intractable seizures (seizures poorly responsive to currently available antiepileptic medications) and cognitive delays in the child. In the past, the ketogenic diet has been used only after several anti-epileptic medications have failed to control seizures. However, given its success in these syndromes, early use (possibly even first-line therapy) should be strongly considered.
The ketogenic diet is also the only proven effective therapy in patients with glucose transporter type 1 deficiency, a disorder classically resulting in intractable seizures, movement disorders and cognitive delay due to inability to transport glucose from the blood to the brain. The ketogenic diet may also be beneficial in cases of focal epilepsy although is less likely to result in effective seizure control than is epilepsy surgery, for those who are candidates for surgical resection.
While traditionally used predominantly in young children, recent findings suggest the ketogenic diet can be effective in adolescents and adults as well.
What Forms of Ketogenic Diet Exist?
All forms of the ketogenic diet require supplementation with calcium and vitamins. For patients who are tube-fed, specific ketogenic formulas exist that make administration very easy.
How Successful Is It?
Approximately half of children experience a greater than 50% reduction in total seizures, and between 10-15% will become seizure-free. Seizure freedom is most commonly obtained in children with specific forms of epileptic encephalopathy such as Myoclonic-Atonic Epilepsy of Doose and West syndrome.
The less stringent forms of the diet (Modified Atkins and Low-Glycemic Index) may be as effective as the traditional diet in many cases. However, some children will achieve better response with the traditional form of the diet, which results in higher ketosis.
How Does It Work?
The exact mechanism by which the ketogenic diet works to control seizures is not understood. Research is ongoing in this area. It is possible that ketones may have direct antiepileptic activity or may act to stabilize the membranes of brain neurons. Also, certain types of fatty acids (polyunsaturated fatty acids) may have antiepileptic activity.
What Are The Side Effects?
Chronic side effects are usually manageable without needing to stop the diet. Most centers advocate regular urine and blood monitoring of the diet to screen for these problems. Side effects may be less problematic with the less stringent forms of the diet.
How is the Ketogenic Diet Started?
The method used to start the ketogenic diet varies by epilepsy center. Younger children are more commonly hospitalized to start the traditional form of the ketogenic diet, whereas older children and adults may be started gradually at home. If the traditional diet is started at home, careful monitoring for vomiting or food refusal is needed.
The Modified Atkins and Low Glycemic Index diet are started at home, without the need for hospitalization.
Medications, Lotions and Products
Most medication formulations for children contain large amounts of sugar, and cannot be used on the ketogenic diet. As a general rule, suspensions or chew tablets are contraindicated. Lotions, such as moisturizers and sunscreens, as well as certain toothpastes can also contain sugar and will prevent ketosis from being achieved. Ketogenic-friendly products should be used whenever possible. (See the list of products at www.charliefoundation.org.)
How long is it continued?
Initiating the diet generally lasts a minimum of one month to determine if it will be effective in reducing seizures. If no improvement is seen in seizure control at that time despite achieving good ketosis (moderate or high levels in the urine), continuing the ketogenic diet is unlikely to be beneficial.
If the diet is effective in improving seizure control, it is usually continued for a minimum of two years and then gradually weaned. Some patients are treated for substantially longer periods of time.
If the diet is effective, medications can often be weaned slowly. While most patients remain on a combination of medication and the diet, some children achieve excellent seizure control on the diet alone.
Elaine Wirrell, M.D.
Last Reviewed: 5/15/11
Article from the May 2011 Epilepsy.com Spotlight Newsletter. Other articles in this issue inclue:
|Lyrica: does it really work?||Dec 21, 2013|
|Hi I'm new to this group||Dec 21, 2013|
|Sodium levels and Trileptal||Dec 21, 2013|
|Need some insight regarding symptoms I feel are possibly seizure related||Dec 21, 2013|
|Grand Mal a week ago - Still feeling dizzy||Dec 21, 2013|
|Seizures return after 30 years?!||Dec 21, 2013|
|My Husband has Narcoleptic Grandmal Seizures and wants a BABY!!||Dec 21, 2013|
|I'm scared, Dilantin is killing me!||Dec 20, 2013|
|Simple partial seizures left untreated||Dec 20, 2013|
|Being a Nurse who has epilepsy||Dec 20, 2013|
|View all Forums|
|topamax and weight loss||19,412|
|Possible cure for absence seizures||16,696|
|How exactly do aura's feel||14,771|
|Sexual Side Effects||13,634|
|MEDICAL ALERT I.D.'s||12,607|
|Over 40 Different Types Of Seizures - Revised||10,553|
|electrical shock in head?||10,131|
|Weight Gain and Depakote||9,035|
|View all Forums|
|Falling Down Funny - It's Harder On Us Than It Is On You||Dec 21, 2013|
|keppra and depakote together?||Dec 20, 2013|
|Overwhelmed||Dec 20, 2013|
|Hyperventilation & epilepsy, a way to help yourself.||Dec 17, 2013|
|Brain Zaps, tics & twitches||Dec 15, 2013|
|Why?!||Dec 15, 2013|
|halfway there!||Dec 13, 2013|
|withdrawal symptoms||Dec 13, 2013|
|women classic snow boots all can get 60% off||Dec 12, 2013|
|update seizure first aid||Dec 12, 2013|
|View all Blogs|
|my partial complex seizures||4,606|
|Topomax... The Dreaded.........||3,805|
|How can you tell if a sleep seizure happens?||3,603|
|Brain Zaps, tics & twitches||3,600|
|side effects of phenobarb.||3,226|
|Tegretol XR and ANXIETY meds||2,907|
|TYLENOL, AEDs & SEIZURES||2,844|
|Nonepileptic "Events" vs. "Seizures"||2,721|
|View all Blogs|
|Cheap Canada Goose Jackets Outlet on sale 60% off online||Dec 12, 2013|
|epilepsy only||Dec 11, 2013|
|Hawaiian and have epilepsy||Nov 28, 2013|
|Epileptics over 50 with poorly controlled seizures||Oct 28, 2013|
|The "CHillin Out" Chat group||Oct 14, 2013|
|Epilepsy Marathon||Oct 13, 2013|
|Epilepsy and Hormones||Oct 5, 2013|
|Epileptics Working from Home for Websites||Sep 18, 2013|
|new worried Mum||Jul 24, 2013|
|Types of Epilepsy||Jul 23, 2013|
|View all Groups|
|Parents Of Children With Epilepsy||269|
|Temporal Lobe Epilepsy||171|
|Women and epilepsy||170|
|Living a life with Epilepsy||133|
|Anyone with Simple Partial Seizures||109|
|Dating and Epilepsy||94|
|Epilepsy and Memory Loss??||88|
|Epilepsy Surgery Group||74|
|Absence Seizures in Kids||73|
|View all Groups|
|i need help understanding||Dec 21, 2013|
|Side effects after right selective amygdalahippocampectomy||Dec 20, 2013|
|Seizures return after 30 year absence?!||Dec 20, 2013|
|Newly diagnosed at age 56||Dec 19, 2013|
|My son`s future||Dec 19, 2013|
|AN Amazing Testimony On A Spell Caster Who help me to get pregnant||Dec 18, 2013|
|Suddenly I'm having seizures after many years with no problem||Dec 17, 2013|
|seizure free for 2 months||Dec 16, 2013|
|My story||Dec 16, 2013|
|my story||Dec 15, 2013|
|View all Stories|
|Temporal Lobe Epilepsy||657|
|Always Have On Clean Underwear||533|
|my brain has died a thousand deaths...........||532|
|Kelly's Life With Epilepsy||496|
|What My Seizures Are Like......||434|
|Nocturnal grand mal seizures (primary generalized epilepsy)||431|
|My Daily Philosophy.....||386|
|View all Stories|