Epilepsy and Ketogenic diet

Epilepsy is a condition where an individual is prone to have recurrent seizures. It is not a single condition; it is a group of disorders where recurrent seizures are the main presentation.

Highest risk of epilepsy is in the first two years of life, the group of children who undergo maximum spurt in neuro-cognitive development. Hence it is imperative to control seizures at the earliest to maximise their development. Standard management of epilepsy is by using anti epileptic drugs. There are several guidelines on which drug to use, dosage to be used in different types of epilepsies. It is a well-known fact that only 60 – 70 % of children with epilepsy have their seizures controlled with anti epileptic medications. The rest 30 – 40% will continue to have seizures irrespective of medications used.

This is a group of children who require constant attention to medications, monitoring development and managing seizure frequency. This invariably puts a huge stress and socio-economic burden on parents and family. It is therefore imperative we consider use of all available treatment strategies in helping these children. Ketogenic Diet is an alternative therapy for epilepsies, which are difficult to control.

Ketogenic diet is a high fat, low carbohydrate and adequate protein diet, which helps body produce ketosis, which is helpful in controlling seizures. Ketogenic diet is not new, it was the norm in treating epilepsies from ancient times. In the late 1920’s when drugs were invented, this diet became sidelined. Over next few decades the role of Ketogenic diet in management of epilepsy reached obscurity.

The credit in sustaining and preserving the science of Ketogenic diet goes to Dr. John Freeman at John Hopkins Hospital in USA. Interest in Ketogenic diet was rekindled by an Hollywood film producer Jim Abrahams whose son Charlie had a severe form of epilepsy which was not responding to standard medications. He sought help from Dr Freeman, under the diet his epilepsy not only was well controlled but also helped him catch up with his development. This inspired Mr Jim Abrahams to set up a charity in the name of Charlie foundation, which has helped in carrying our several researches in the field of Ketogenic diet. He also made a movie with Mery Streep in the lead role called First Do No Harm which would be recommendable movie for families interested in the diet.

Ketogenic diet mimics body being starved, and compels body to use ketones, particularly the brain in using Ketones over sugars, which seem to have a stabilizing effect on abnormal electrical activity in the brain. Ketosis is a natural mechanism in the body when we starve; the body produces Ketones as an alternative energy source for the brain to use in the absence of sugars. Ketogenic diet does it without forcing the person to fast.

Efficacy of this diet in managing epilepsy, particularly in children is proven beyond doubt, however it is important to highlight that it doesn’t work in everyone. It should neither be seen a magic bullet for complex epilepsy.

Like anything else in life it has it’s risks and benefits, in addition to helping in reducing seizure frequency and intensity, it also helps in general improvement in quality of life such as alertness, cognitive response and development. The main side effects include diarrhea, vomiting, and constipation.  In addition, electrolyte disturbances, increased lipid levels and renal stones are other side effects that need to be actively monitored for. Not all children can be started on the diet, there are specific conditions where it is clearly contraindicated and hence it is vital that these conditions are ruled out before starting the diet.

Managing Ketogenic diet requires a team with expertise in this field, a paediatric neurologist, dieticians trained in Ketogenic diet and a good lab to carry out special tests are required. The diet is patient specific and calculated according to calorie requirement and monitored thereafter with fine-tuning whenever required.

Ketogenic diet generally meant the classic variety where the diet has 3 portions of fat for 1 portion of carbohydrates and protein. However, it is not always palatable to all individuals and hence several alternate to classic diet has been tried such Modified Atkins, Low Glycemic index diet and MCT diet. With proven role in childhood epilepsy, now it is being tried in adults and also in varied other conditions such as Autism, Cancer, Alzheimer’s and many other health conditions.

Aster NEUKIDS at Aster CMI is starting a formal Ketogenic Diet Clinic from February 2019. We are launching the clinic on International Epilepsy day on 11th February 2019.

 

Please join us for a an informal discussion at Aster CMI Hospital, please call us on 7829910888 for more information.

 

Dr C P Ravi Kumar

Consultant Paediatric Neurologist

MRCPCH, CCT in Paediatrics (U.K.)

Fellow in Paediatric Epilepsy & Neurology (London)

Aster CMI Hospital, Hebbal.

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