Article

Epilepsy’s Big Fat Answer

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Abstract

Editor’s note: Epilepsy and seizures affect nearly 3 million Americans of all ages. The incidence is greater in African-Americans and in socially disadvantaged populations, and about 200,000 new cases of epilepsy are diagnosed each year. Despite these alarming figures, no magic pill exists to eliminate convulsions. While drugs work for some, others find them ineffective. What seems to work just as well, if not better, especially in children, is a relatively unknown, high-fat diet. The author, John M. Freeman, M.D., one of the nation’s leading advocates for its use, writes about the evolution of the diet and its struggle for acceptance.

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... The ketogenic diet was first introduced and developed by Russell M. Wilder, of the Mayo Clinic in the 1920s to treat children with epilepsy. The idea was originally conceived from an osteopath and faith healer, Hugh Conklin, who successfully treated children's epilepsy with a diet that induced starvation-like conditions [21]. Apparently, the effects of starvation could be mimicked by a diet low in carbohydrates and high in fat and was demonstrated to be effective in managing epilepsy in children [22,23]. ...
... The ketogenic diet's objective is to achieve ketosis with the generation and conditioning the human body to use ketones as source of energy for cells including the brain, replacing glucose. Since this low carbohydrate diet (with total daily carbohydrate intake of less than 20 g) caused ketosis, it became known as the ketogenic diet [21]. The classic ketogenic diet consists of a 4:1 ratio of fats to proteins and carbohydrates [24]. ...
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... Hugh Conklin, an osteopath and faith healer, successfully treated children's epilepsy with a diet that induced starvation-like conditions. 2 As pharmaceutical firms developed new, effective anticonvulsant medications in the ensuing decades, the KD fell out of favor. It was easier to take a medication than track food intake diligently. ...
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The ketogenic diet has been widely and successfully used to treat children with drug-resistant epilepsy since the 1920s. The aim of this study was to test the efficacy of the ketogenic diet in a randomised controlled trial. 145 children aged between 2 and 16 years who had at least daily seizures (or more than seven seizures per week), had failed to respond to at least two antiepileptic drugs, and had not been treated previously with the ketogenic diet participated in a randomised controlled trial of its efficacy to control seizures. Enrolment for the trial ran between December, 2001, and July, 2006. Children were seen at one of two hospital centres or a residential centre for young people with epilepsy. Children were randomly assigned to receive a ketogenic diet, either immediately or after a 3-month delay, with no other changes to treatment (control group). Neither the family nor investigators were blinded to the group assignment. Early withdrawals were recorded, and seizure frequency on the diet was assessed after 3 months and compared with that of the controls. The primary endpoint was a reduction in seizures; analysis was intention to treat. Tolerability of the diet was assessed by questionnaire at 3 months. The trial is registered with ClinicalTrials.gov, number NCT00564915. 73 children were assigned to the ketogenic diet and 72 children to the control group. Data from 103 children were available for analysis: 54 on the ketogenic diet and 49 controls. Of those who did not complete the trial, 16 children did not receive their intervention, 16 did not provide adequate data, and ten withdrew from the treatment before the 3-month review, six because of intolerance. After 3 months, the mean percentage of baseline seizures was significantly lower in the diet group than in the controls (62.0%vs 136.9%, 75% decrease, 95% CI 42.4-107.4%; p<0.0001). 28 children (38%) in the diet group had greater than 50% seizure reduction compared with four (6%) controls (p<0.0001), and five children (7%) in the diet group had greater than 90% seizure reduction compared with no controls (p=0.0582). There was no significant difference in the efficacy of the treatment between symptomatic generalised or symptomatic focal syndromes. The most frequent side-effects reported at 3-month review were constipation, vomiting, lack of energy, and hunger. The results from this trial of the ketogenic diet support its use in children with treatment-intractable epilepsy. HSA Charitable Trust; Smiths Charity; Scientific Hospital Supplies; Milk Development Council.
Ketogenic Diets: Treatments for Epilepsy and Other Disorders Fifth Edition
Ketogenic Diets: Treatments for Epilepsy and Other Disorders Fifth Edition. Kossoff EH, Freeman JM, et al. demosHealth, New York, 2011.
Seizures and Epilepsy in Childhood: A Guide for Parents
  • Jm Freeman
  • Epg Vining
  • Dj Pillas
Freeman JM, Vining EPG and Pillas DJ: Seizures and Epilepsy in Childhood: A Guide for Parents. Johns Hopkins University Press. Baltimore, Maryland. 3rd edition 2002.