A high-fat, low-carbohydrate diet with moderate protein can reduce the frequency of seizures and significantly improve overall health of some children with drug-resistant epileptic syndromes, according to recent research.
Dating to the 1920s, the ketogenic diet was designed to change the source of body energy from carbohydrates to fats. This change promotes the use of ketone bodies — compounds produced during the metabolism of fats — as source of energy, which is thought to have an antiepileptic effect.
The ketogenic diet is currently used as a therapeutic approach for refractory epilepsy in more than 70 countries around the world, as well as in most epilepsy centers in the United States.
The study enrolled 52 children aged 3 months to 7 years who were followed at the Shengjing Hospital of China Medical University from 2012 to 2015. All children had been treated with at least two types of antiepileptic drugs as standard treatment without any obvious clinical improvements.
Twenty-two participants were girls and 30 were boys who had been diagnosed with drug-resistant epileptic encephalopathy — including West syndrome, Lennox-Gastaut Syndrome, Doose Syndrome, and Dravet Syndrome — for at least 2 months.
The ketogenic diet regimen was prepared in accordance with the modified Johns Hopkins program. The basic principle of the diet consists of reducing calorie intake by about 75 percent of the total recommended for each age and body weight, and regulated in accordance with the child’s general activity. The children would receive ketone-based products with added protein, minerals, vitamins, and dietary fibers.
After 12 weeks on the diet, 14 children showed complete seizure remission, nine experienced only rare epileptic episodes (remission 90%–100%), six showed significant improvements (remission 50% to 90%) and 23 did not experience any significant improvements (remission less than 50%).
Interestingly the effects of the ketogenic diet differed between epileptic syndromes. At 12 weeks after treatment began, children with Doose syndrome benefited the most, as the diet effectively reduced seizure frequency in 100% of participants, followed by children with West syndrome, with an effective response rate of 57.9%.
All Dravet patients had an effective response rate of 50% to the diet, followed by 42.9% of those with Lennox-Gastaut syndrome.
Patients’ brain activity — as measured by electroencephalogram (EEG) — significantly improved in 19 patients after 12 weeks of treatment. Also, a hallmark EEG pattern of epileptic seizures, called the spike-wave index, was significantly reduced in 26 children.
A total of 23 children showed significant improvement in their cognitive function. Twelve patients experienced language improvement and 10 experienced motor function improvements at 12 weeks of treatment.
During the study, 23 patients experienced adverse reactions, including 20 who had varying degrees of digestive symptoms. However, most problems subsided when the symptoms were treated.
“The basic purpose of KD treatment is to control seizures, reduce, and discontinue using medications, and to improve the cognitive ability of children” the authors wrote. “… KD therapy plays an important role in the treatment of pharmacoresistant epileptic encephalopathy, and is important for the treatment of children with epileptic encephalopathy treatment,” they added.
For children with pharmacoresistant epileptic encephalopathy, “KD treatment is regarded as a clinically effective treatment option when the regular combination of a variety of antiepileptic drugs are ineffective, so KD treatment is worthy of wide application by pediatric neurologists,” the researchers concluded.
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