Comprehensive Epilepsy Center
Ketogenic Diet Therapy
Background
The ketogenic diet was first developed in 1921 by a physician at the Mayo Clinic by a physician who observed that fasting
epilepsy patients had fewer seizures. While a complete fast cannot be sustained, seizure control can be continued by "tricking"
the brain into reacting as though fasting was still in progress. This is accomplished through dietary modifications.
Description
The dietary modification "trick" relies upon forcing the body to convert fat to ketones. Ketones, in turn, are used by the
brain as an energy source when its normal fuel, glucose, is unavailable. The ketogenic diet makes glucose unavailable to the
brain by restricting access to the carbohydrate foods, which are the body's customary source of glucose. The calories (heat
energy units) usually provided by the carbohydrate foods, are replaced with dietary fats. Very strict adherence to the diet
is required. All food and medications must be weighed and figured into the dietary plan. These steps are essential in order
for the ketogenic diet to be effective.
Successful and safe use of the diet relies on the cooperation of a multi-disciplinary team and a motivated patient. The ketogenic
diet is not always successful and is not always tolerated. The Jefferson Comprehensive Epilepsy Center has assembled a team
of dieticians, nurses, physicians and psychologists to help patients and their families have the best chance of success with
the ketogenic diet therapy option.
New Interest in the Diet
While effective anti-epileptic drugs and surgical treatments are available to suppress seizures in the majority of patients,
20%-30% do not obtain adequate seizure control. However, recent clinical studies have demonstrated that the ketogenic diet
can produce results which compare favorably with available anti-epileptic drugs and can be of help even when drug therapy
has failed. The mechanism of ketogenesis is well understood, but the reason that it suppresses seizures is not known. Because
it has been shown to be effective, there has been increasing interest in systemic introduction of ketogenic diet therapy to
help patients with refractory epilepsy.
Our Results
Several trials have been done in children. However, there have been no studies demonstrating the effect of this diet on seizures
in adults. Our center is the first of its kind with an emphasis on adult and adolescent epilepsy patients.
Based on our results several conclusions can be drawn:
- The ketogenic diet is helpful in 60% of patients.
- Improvement in mood and increased energy levels are noted.
- Approximately less than 20% of the patients withdraw due to side effects.
Potential Side Effects:
- Kidney stones
- Evaluation in the uric acid level (hyperuricemia)
- Blood condition in which the bicarbonate concentration is below normal (acidosis)
- Decreased calcium level (hypocalcemia)
- Refusal to eat
- Others may occur which are not yet known
Initiating the Ketogenic Diet
Starting the diet involves a hospital stay during which a patient fasts under medical supervision until sufficient ketones
are released. Once this has occurred, the diet is started slowly over 2-3 days until one entire day of meals has been tried.
During the hospitalization, individuals are watched closely for hypoglycemia (low blood sugar) and are educated about home
use of the diet. The approximate length of the hospital stay is 5 days.
Who is a Candidate?
Due to dietary restrictions involved with this diet, particularly the high fat content, the diet is not a good option for
everyone. Careful screening for medical conditions that might be made works by the diet must be performed and close monitory
must be performed on a regular basis after the diet is initiated. Each person must be evaluated carefully by health care professionals
who are experienced in the diet before the start of the diet.
If you are considering the diet, there are some questions that you might want to ask yourself to determine whether the diet
could be helpful to you.
- Do you have uncontrolled seizures despite taking medications?
- Do you experience intolerable side effects from medications for seizures?
Some of the Criteria we use:
- The diagnosis of epilepsy should be definite.
- The patient should be 50 years of age or younger.
- No history of certain types of heart disease or stroke.
- Cholesterol and lipids should be in an acceptable range.
- The patient or caregiver must be able to prepare the necessary meals.
Conclusion
For some people the ketogenic diet offers an alternative means of controlling seizures when medicines have failed or are not
well tolerated. It requires strict attention to all aspects of the diet and requires screening tests to determine whether
the diet is a suitable option. However, when tolerated, the diet is helpful in the majority of people who continue the diet.
If you are interested in discussing the diet and to find out if the diet is an option for you, please contact the Jefferson
Comprehensive Epilepsy Center at 215-955-4624 to set up an appointment with one of our physicians.
Please check with your health insurance carrier for plan coverage of the ketogenic diet.
Ketogenic Diet
