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Ketogenic Diet


Despite the advances in medications to control seizures associated with Lennox-Gastaut syndrome (LGS), many people do not always completely respond to these treatments. When that has happened, some parents and caregivers have consulted with their doctors about other forms of therapy such as dietary treatments to add to their current treatments.

The information provided below is for your background only. Before making any decision regarding the use of this diet or any other nonmedicinal treatment, please consult your healthcare professional.

History of the ketogenic diet

Since the 1920s, the ketogenic diet has been used as an option for the treatment of intractable epilepsy. The classic ketogenic diet is a high-fat, low-protein, and low-carbohydrate diet used to help control epileptic seizures.1-3 Foods eaten include heavy whipping cream, oils, mayonnaise, butter, eggs, meats, and green vegetables. There are also many different ketogenic formulas for infants or children with feeding tubes.

Understanding how the diet works is a mystery1

During the ketogenic diet, the energy that the body and brain need comes from burning fat instead of glucose.2 Fat is converted into ketone bodies in the body, which provide fuel to the brain.2 It is unclear if ketone bodies—or some other mechanism—are responsible for the diet working. The ketogenic diet has strict rules and requires a commitment from the patient and the entire family. Patients usually start the ketogenic diet in the hospital, and have regular follow-up appointments to confirm that they are doing well. Ketogenic diet teams include a neurologist as well as a dietitian.

In some children and adults with epilepsy, the ketogenic diet might help reduce seizure frequency.3-5


Several studies offer hope

A study that combined and analyzed the data from 19 clinical studies of the ketogenic diet in children with epilepsy (meta-analysis), showed that children with generalized epilepsy syndromes who are on the diet may have a greater chance of obtaining both improved seizure control and/or antiepileptic drug reduction.3 In a study to assess the efficacy of the ketogenic diet in the treatment of drug-resistant epilepsy in children 2-16 years of age, it was shown that 28 (38%) of the 73 children who were on the ketogenic diet had greater than 50% seizure reduction compared with 4 (6%) of the patients who were not on the ketogenic diet.5

Diet alternative for adult patients

Adult patients, on the other hand, may sometimes be unwilling to try the ketogenic diet simply because of the lifestyle change it represents—no fast food, no high-carb snacks, and more. But the recent introduction of the modified Atkins diet (MAD) might be changing that. In a recent MAD study that was conducted in adult patients with intractable epilepsy who were older than 18 years of age, 47% of adults had a greater than 50% reduction in their seizures by 3 months.4

Side effects can be serious

The ketogenic diet might have some significant side effects.6 Long-term adverse events include renal stones, constipation, gastrointestinal symptoms, weight loss, decreased growth, carnitine deficiency, and abnormal lipid profile.1,6 Serious adverse events have also been reported in a small number of patients, and include cardiac abnormalities due to selenium deficiency and pancreatitis.1 Children receiving the ketogenic diet continuously for longer than 6 years are at high risk for kidney stones, bone fractures, and growth disturbances, but not dyslipidemia.1

Make sure to talk with your healthcare professional before starting this or any other diet.

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References:
1.  Kossoff EH, Zupec-Kania BA, Rho JM. Ketogenic diet: an update for child neurologists. J Child Neurol. 2009;24(8):979-988.
2.  Hartman AL, Gasior M, Vining EPG, Rogawski MA. The neuropharmacology of the ketogenic diet. Pediatr Neurol. 2007;36(5):281-292.
3.  Henderson CB, Filloux FM, Alder SC, Lyon JL, Caplin DA. Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis. J Child Neurol. 2006;21(3):193-198.
4.  Kossoff EH, Rowley H, Sinha SR, Vining EPG. A prospective study of the modified Atkins diet for intractable epilepsy in adults. Epilepsia. 2008;49(2):316-319.
5.  Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008;7(6):500-506.
6.  Lee PR, Kossoff EH. Dietary treatments for epilepsy: management guidelines for the general practitioner. Epilepsy Behav. 2011;21:115-121.


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