The ketogenic diet, a high-fat, adequate-protein and low-carbohydrate diet, is regaining popularity in treating difficult-to-control cases of epilepsy, particularly in children. The classic ketogenic diet contains a 4 to 1 ratio by weight of fat to combined amounts of protein and carbohydrates.

The diet has proven to be effective in half of the patients who try it, and very effective in one third of the patients. It has given new hope to parents whose epileptic children status couldn’t be improved by anticonvulsant medication.

After stroke, epilepsy is one of the most common neurological disorders. It is estimated that if affects 50 million people worldwide. Most people with epilepsy can successfully control their seizures with medication. However, 20 to 30 percent fail to do so, despite trying different drugs. Particularly for them the diet is again proven valuable in epilepsy management.

Knowledge of this diet isn’t new. Ancient Greek physicians treated diseases, including epilepsy, by altering their patient’s diet.

In the book “Epidemics,” Hippocrates describes the case of a man whose epilepsy was cured with drastic diet and fasting. Erasistratus, a Greek anatomist and royal physician under Seleucus I Nicator of Syria stated, “One inclining to epilepsy should be made to fast without mercy and be put on short rations.”

In modern times, the first study of fasting as a treatment for epilepsy was conducted n France in 1911. A few years later, an osteopathic physician named Hugh Conklin from Battle Creek, Michigan, treated his epilepsy patients with fasting and obtained very good results. Because he believed that epilepsy was caused by a toxin produced in the intestines he recommended a fast lasting 18 to 25 days and a “water diet” to allow the toxin to be eliminated from the body.

In 1921, Dr. Rusell Wilder, at the Mayo Clinic, used previous research in coining the name “ketogenic” to describe a diet that produced a high level of compounds called ketones in the blood through an excess of fat and lack of carbohydrates. During the 1920s and 1930s, when there were only a few effective anticonvulsant drugs, this diet was widely used and studied to treat epilepsy. In 1938, with the discovery of phenytoin, an anticonvulsant drug, the focus shifted to developing new compounds of this kind.

The ketogenic diet has had a revival in recent times after it was found that children with difficult-to-treat epilepsy were more likely to find relief with the ketogenic diet than to benefit from trying a different anticonvulsant drug. There is now evidence that adolescents and some adults can also benefit form this diet. However, children with a focal brain lesion are more likely to become seizure-free with surgery than with the ketogenic diet.

This year, “epilepsy action,” from the U.K., published a review of the diet in which they state: “The ketogenic diet has recently been “rediscovered” and is achieving increasingly widespread use. Its modern role as an alternative management for children with difficult-to-control epilepsy is currently being re-defined.”

In 2009, at the 63rd Annual Scientific Conference of the American Epilepsy Society, Eric Kossoff, M.D., from Johns Hopkins in Baltimore, stated that “many clinical ketogenic diet experts realize that the ketogenic diet works so well that perhaps we should be using it before epilepsy becomes so difficult to control that families become angry it wasn’t tried earlier.”

ABC News had a piece of news this year about the increasing use of the diet, particularly in children difficult-to-treat with anticonvulsants.

Although the ketogenic diet can be very effective, it is not totally benign, and there may be complications from its use.

About 1 in 20 children on the ketogenic diet will develop kidney stones, which can be prevented to a certain extent by providing some specific supplements.

In adults, some common side effects include weight loss, constipation and raised cholesterol levels.

In addition, the diet can present some difficulties to caregivers and to the patients due to the time commitment involved in planning meals and measuring the ingredients, particularly because a strict adherence to the dietary plan is required. However, since the diet can provide a treatment for children without the use of dangerous drugs, it is an approach worth taking when dealing with this serious disease.

Cesar Chelala, M.D., is an international public health consultant.

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