The implementation of a ketogenic diet (KD) to treat intractable childhood epilepsy has ancient origins. As elements of the treatment have advanced over the centuries, clinicians are hopeful the diet’s uses can be expanded to address other neurological disorders.
The CDC estimates 1 percent of children ages 0–17 (approximately 750,000) are affected by epilepsy or seizure disorders. The majority of these children receive first line pharmacologic treatment, which effectively treats their epilepsy. However, 20–30 percent of patients do not respond to medications, and one of the most efficacious alternative therapies is the KD.
The History of Ketogenic Diets
Use of the diet dates back to 500 B.C., when instances of fasting and diet modifications were reported as a treatment for epilepsy. In modern times, the use of starvation to treat epilepsy was noted by two Parisian physicians, Gulep and Marie, in 1911. Physicians and others within the healthcare community began experimenting with fasting to manage epilepsy in the United States during the early 20th century.
A diet-based approach to epilepsy management continued to gain popularity, especially after Drs. Wilder and Peterman of the Mayo Clinic developed a specific formula in 1924. However, as researchers developed better antiepileptic pharmacologic treatments, use of the ketogenic diet declined.
More recently, observational and clinical studies have begun to reassert its importance for treating intractable epilepsy in children as well as adults. The KD and its variations (modified Atkin’s diet, low glycemic diet, medium-chain triglyceride diet) are now used in over 45 countries worldwide.
In clinical practice, patient families more frequently drive the conversation back to this nonpharmacological treatment. Parents of children who have epilepsy often come across the KD in online research and bring it up to a child’s physician. Instead of being a fallback measure, the KD is becoming a first line of defense.
The prevailing theory behind the mechanism of the KD is that the high-fat, low-carbohydrate, adequate-protein approach encourages the production of ketones within the body which, in turn, act in the brain to reduce seizures. The exact mechanisms behind ketones’ ability to counteract seizures are not yet fully understood, but there are at least four working theories under ongoing research.
Developing the correct ratio of fat to carbohydrate and protein consumption is a delicate process requiring strict compliance and monitoring. A multi-disciplinary approach, with dietitians, nursing, clinicians, pharmacists, social workers as well as parents, teachers and other care providers is critical. Usually, children are only kept on the ketogenic diet for two years. Besides effects on seizure frequency, patients report increased alertness, improved concentration and developmental gains. Diet therapy is overall tolerated in well-chosen patients, but some side effects can be seen.
Growing number of publications summarizing one century of data confirm its reliable efficacy, with over half of children on the diet experiencing a 50 percent reduction in the number of seizures and 10–15 percent, even becoming seizure-free.
With the resurgence of interest in the KD, clinicians are beginning to consider its potential for treating other neurologic disorders including, but not limited to, autism, Parkinson’s disease, Alzheimer’s disease, malignant brain tumors, migraine, neuromuscular disorders and multiple sclerosis. There is also growing experience in use of KD for patients with medically refractory status epilepticus.
Dr. Lucyna Zawadzki is board-certified in Neurology with special qualifications in Child Neurology, Epilepsy and Neurophysiology. She is Director of Pediatric Epilepsy and Neurophysiology at Akron Children’s NeuroDevelopmental Science Center in Akron, Ohio.
Source: MD News