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A special diet may be recommended for children with
intractable epilepsy (epilepsy that is not relieved
by medication). The high-fat, low-carbohydrate Ketogenic
Diet is carefully designed to help the patient’s body
make large amounts of ketones, which are produced when
fats are processed in the liver. The diet helps reduce
the number of seizures in some patients, although precisely
why this beneficial effect occurs is not known. Researchers
have been exploring the role of beta-hydrozybutyrate,
a by-product of ketosis that inhibits seizures in animals.
Basics of the Ketogenic Diet
The Ketogenic Diet has been used as a treatment for
epilepsy since the 1920s, but as antiepileptic drugs
(AEDs) were developed, it became a less popular tool.
However, there has been a renewed interest in the diet
for patients who have not responded well to AEDs or
for those wishing to avoid the side effects associated
with those medicines.
While there are several variations of the diet,
the general philosophy is the same. The diet commences
with a 24- to 48-hour fasting period that begins in
the hospital and is carefully monitored. Then the actual
food plan, characterized by large quantities of high-fat
foods, begins. The body goes into a survival phase,
using the fats as a major energy source to produce the
ketones. In general, of every six calories consumed,
four are from fats and the other two are from protein
and carbohydrates.
The Ketogenic Diet is stringent, and it requires
a great deal of motivation by the patient and his or
her caregiver for total compliance.
What Foods are on the Ketogenic Diet?
The diet consists of three categories of food: unrestricted,
fatty, and restricted. Some examples of unrestricted
foods include vegetables, such as broccoli, carrots,
lettuce, and spinach, artificial sweeteners; and unsweetened
fruit. The fatty foods include bacon, hot dogs, potato
chips, nuts, cream, eggs, mayonnaise, and butter. Restricted
foods include candy and items containing sugar. A vitamin
supplement is necessary to ensure that adequate nutritional
needs are met. Snacking between meals is not allowed.
A dietitian provides the patient and family with
a foods list that must be strictly followed. Food portions
are weighed to keep in harmony with the diet’s delicate
balance.
Why Try the Diet?
The Ketogenic Diet is used for patients whose seizures
have not been well controlled by antiepileptic drugs
(AEDs). The diet, while difficult to comply with, has
had positive results. About one-third of the children
who are on the diet gain full control of their seizures,
while another one-third have partial seizure control.
There are none of the side effects associated with AEDs.
In time, the diet is tapered off so the child can resume
a regular diet.
There are some aspects of the diet to consider.
Children who follow this diet typically experience delays
in growth; after the diet is tapered off, however, there
tends to be a growth spurt. Nausea and vomiting may
occur during the fasting period, and the diet itself
may produce those effects as well as constipation. Kidney
stones may result from a build-up of uric acid in the
blood.
Perhaps the hardest part of the Ketogenic Diet
is compliance. It is a challenge to avoid carbohydrates,
especially for young children. A commitment by the patient’s
family to help him or her follow the diet is key. The
University Comprehensive Epilepsy Center has treated
scores of children with this diet and can provide the
expertise and practical advice necessary to make the
most of this treatment.
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Epilepsy
and Children
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