Ketogenic Diet & Epilepsy

The ketogenic diet is not so much a diet as it is an alternative therapy for children with difficult-to-control epilepsy, which is usually defined as having two or more seizures a week even when using two or more anticonvulsant medications. It is a high-fat and low-carbohydrate diet that actually mimics the effects of starvation on the body and uses the body's natural processes to control seizures.

How It Works

When the body does not have carbohydrates available for fuel, the liver converts fat for use, producing ketone bodies that are used by the brain as an energy source. This is called ketosis. Although researchers do not completely understand why it works, these ketones have an anticonvulsant effect. The ketogenic diet has been proven to be effective in controlling seizures, reducing them in approximately 50 percent of children, and sometimes eliminating them completely.

Process

The diet is prescribed by a doctor and should not be attempted without medical supervision. A dietitian will recommend a daily diet that strictly controls the number of calories, the amount of protein, and the ratio of fat to carbohydrates and protein for the child. Fats consumed typically include butter, heavy cream, mayonnaise, and canola or olive oil, and meals have to be carefully prepared to strictly regulate the amount of carbohydrates and protein consumed. Even small amounts of excess carbohydrate can drastically decrease effectiveness.

The first stage of the diet is typically a medically supervised fast, typically in a hospital setting. After a 24-hour fast, food is gradually reintroduced. Some research has indicated that fasting may not be necessary for long-term success, but ketosis does occur more quickly with a fast. There are other advantages to the hospitalization, however. It allows the child to be monitored for any increase in seizures, and is an opportunity to educate the family about the specifics of the diet.

Side Effects

Like any medical treatment, there are possible side effects to the ketogenic diet. The change in diet may cause the child to feel sluggish or lethargic for the first few days. Side effects from long-term use can include slowed growth, bone fractures, constipation, dehydration, kidney stones, and high cholesterol levels. A dietitian normally recommends supplements, because the ketogenic diet does not provide the vitamins and minerals of a normal balanced diet.

Medications

Anticonvulsant medications will be carefully monitored while the child is on the diet but usually are not reduced. The doctor will need to see the child at least every three months, if not more often, so that his growth can be measured and blood and urine tests done to diagnose any medical problems early.

Stopping the Diet

Although it is possible to remain on the ketogenic diet for years, the doctor may suggest going off the diet if seizures have been well controlled for some time. Because of the risk of increased seizures if the diet is stopped abruptly, the child will normally be gradually returned to a normal diet. As with all aspects of the ketogenic diet, stopping the diet should be done only with medical supervision.