Diets helps those with refractory epilepsy
People with epilepsy have seizures. During a seizure, the nerve cells in the brain don’t communicate normally. The usual electrical activity in the brain becomes altered. These seizures may last a few seconds or a few minutes.
About one-third of people with epilepsy will eventually develop refractory epilepsy; which means that medicines don’t work well, or at all, to control the seizures. About one in three people with epilepsy will go on to develop refractory epilepsy.
Pavel Klein, M.B., B., Chir., of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Maryland, member of the American Academy of Neurology and study’ s author commented “We need new treatments for the 35 percent of people with epilepsy whose seizures are not stopped by medications.” “The ketogenic diet is often used in children, but little research has been done on how effective it is in adults.”
Klein and colleagues reviewed adjunctive ketogenic diet (KD) and modified Atkins diet (MAD) treatment of refractory epilepsy in adults. Only a few studies have been published, all open-label. Due to the inconsistent uncontrolled nature of the studies the researchers examined all studies individually, without a meta-analysis.
The ketogenic and modified Atkins diets include items such as bacon, eggs, heavy cream, butter, leafy green vegetables and fish. The ketogenic diet consists of a ratio of fat to protein/carbohydrates of three or four to one by weight. The modified Atkins diet has a one-to-one fat to carbohydrate/protein ratio by weight.
The researchers reviewed five studies on the ketogenic diet with a total of 47 people included in the analysis and five studies on the modified Atkins diet with 85 people included.
The researchers found across all studies 32 percent of people treated with the ketogenic diet and 29 percent of people treated with the modified Atkins diet achieved 50 percent or more seizure reduction, including nine percent in the ketogenic treatment group and 5 percent in the modified Atkins group had a greater than 90 percent reduction in seizures.
The effect persists long term, but, unlike in children, may not outlast treatment. The 3.1 and 4.1 carbohydrate + protein in both diets were similar.
The anticonvulsant effect occurs quickly with both diets, within days to weeks. Side effects of both diets are benign and similar. The most serious, hyperlipidemia, reverses with treatment discontinuation. The most common, weight loss, may be advantageous in patients with obesity
Possible barriers to large-scale use of both diets in adults include low rate of diet acceptance and high rates of diet discontinuation. Fifty-one percent of the ketogenic diet and 42 percent of modified Atkins diet treated patients stopped the diet before study completion. Refusal to participate was due to diet restrictiveness and complexity, which may be greater for ketogenic diet than the modified Atkins diet. However, long-term adherence is low for both diets. Most patients eventually stop the diet because of culinary and social restrictions.
In summary the researchers write “ketogenic diet and modified Atkins diet treatment show modest efficacy, although in some patients the effect is remarkable. The diets are well-tolerated, but often discontinued because of their restrictiveness. In patients willing to try dietary treatment, the effect is seen quickly, giving patients the option whether to continue the treatment.”
In closing Klein commented “Unfortunately, long-term use of these diets is low because they are so limited and complicated. Most people eventually stop the diet because of the culinary and social restrictions.” “However, these studies show the diets are moderately to very effective as another option for people with epilepsy.”
Dietary treatment in adults with refractory epilepsy: A review. Neurology, October 2014 DOI: 10.1212/WNL.0000000000001004
Newswise American Academy of Neurology (AAN)