Ketogenic Diet in Epilepsy

Epilepsy is a disabling and common neurological disease, which can be controlled successfully in most patients with one or more antiepileptic drugs. Some of these patients are not surgery candidates, so it is necessary to search for alternative treatments for epilepsy such as palliative surgery, neuromodulation, and a ketogenic diet. Recent studies have found a significantly positive outcome with the use of the ketogenic diet for treatment of refractory epilepsy in children.

Ketogenic Diet

The ketogenic diet, or keto diet, is a medical or therapeutic diet — a diet designed to help manage or treat a medical condition. The keto diet is suggested for children with epilepsy that continues despite medication. The keto diet is high in fat, adequate in protein and very low in carbohydrates (carbs). A typical keto diet consists of 70% to 80% fats, 20% proteins and 5% to 10% carbohydrates.

Who Will It Help?

• Doctors usually recommend the ketogenic diet for children whose seizures have not responded to several different seizure medicines.
• The ketogenic diet has been shown in many studies to be particularly helpful for some epilepsy conditions. These include infantile spasms, Rett syndrome, tuberous sclerosis complex, Dravet syndrome, Doose syndrome, and GLUT-1 deficiency.
• The diet works well for children with focal seizures, but may be less likely to lead to an

immediate seizure-free result.

• The diet is sometimes started to help reduce or even stop anti-seizure drugs.

Pre-keto diet Counseling and Evaluation

Before starting the diet, the patient should maintain a seizure diary to establish a frequency parameter. Laboratory evaluation including selenium and carnitine levels electroencephalogram (EEG), and a magnetic resonance image (MRI) of the brain are required. The nutritional evaluation includes a nutritional anamnesis including a 3-day food report, food habits, allergies, aversions, and intolerances. Baseline weight, height, and the ideal weight for stature and body mass index (BMI) are needed to calculate the ketogenic ratio, calories, and fluid intake. The diet formulation should be established according to the patient’s age and the administration route.

What to Expect

The ketogenic diet is not something that can be tried casually. It's a big commitment, and starting it by own is risky. Parents and their child need to work closely with a team of experts.

Prepare for a few days in the hospital: Doctors often want to keep an eye on kids when they start the diet to make sure they're doing well.

Work closely with a dietitian: The ketogenic diet is tailored to each child. So a dietitian will give the detailed info on exactly what the child can eat and how much. Since the ketogenic diet is low in important nutrients, therefore the child will probably need supplements of calcium, vitamin D, iron, folic acid, and others.

Visit the doctor regularly: Your child will need regular checkups every 1 to 3 months at first. The doctor will chart their growth and weight, test their blood and urine, keep an eye on cholesterol and decide whether to tweak the diet or medication dose.

Stick with the diet for a few months at least: If it works, one should notice fewer seizures by then or even sooner. If the diet doesn't help, the child will gradually return to a normal eating plan. If they stop the ketogenic diet suddenly, it could trigger seizures.

Effectiveness of Ketogenic Diet

Studies generally show that about a third of children with epilepsy who follow the ketogenic diet will have at least a 90% reduction in seizures, and another third will experience a reduction of between 50% and 90%. This is remarkable, considering that these patients are generally those whose seizures are not well-controlled with medications.

How Is The Patient Monitored Over Time?

• Early on, the doctor will usually see the child every 1 to 3 months.
• Blood and urine tests are performed to make sure there are no medical problems.
• The height and weight are measured to see if growth has slowed down.

Can The Diet Ever Be Stopped?

• If seizures have been well controlled for some time, usually 2 years, the doctor might suggest going off the diet.
• Usually, the person is gradually taken off the diet over several months or even longer. Seizures may worsen if the ketogenic diet is stopped all at once.
• Children usually continue to take seizure medicines after they go off the diet.

Are There Any Side Effects of Ketogenic Diet?

A child starting the ketogenic diet may feel sluggish for a few days after the diet is started. This can worsen if a child is sick at the same time as the diet is started. Other side effects that might occur if the diet is taken for a long time are:

• Kidney stones
• High cholesterol levels in the blood
• Constipation
• Slowed growth
• Bone fractures

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