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Low carb ketogenic diets succeed for seizures: Challenges of epilepsy

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Ketogenic diets have existed for decades for epilepsy. When new drugs emerged on the market, however, they were rarely used. Now an increasing number of physicians are turning to ketogenic diets again when drugs fail, with support offered in a new study from Argentina, reported Epilepsy Today on July 17.

The researchers focused on a condition known as Lennox-Gastaut syndrome (LGS). They began by choosing 20 children who had two types of LGS: Cryptogenic LGS (no known cause) and structural LGS (caused by a brain malformation).

The children followed a ketogenic diet for 16 months. Of the 15 who had maintained the plan, three were seizure-free. An additional three of the children experienced reductions in seizure frequency between 75 to 99 percent.

In addition, two children reduced their seizure frequency between 50 to 74 percent, while the other seven also experienced fewer seizures. Overall, three children stayed seizure-free even after they were weaned from the diet.

Founder of a ketogenic non-profit called Matthew's Friends, Emma Williams offered her views on when and how ketogenic diets should be used as alternative therapies to medication. "In an ideal world, ketogenic therapy should be considered for all children whose seizures fail to respond to the first two appropriate medications. The longer any child waits for effective seizure management, the higher their risk of long-term impairments in all aspects of life," she said.

Eric Kossoff, M.D., discussed ketogenic diets for conditions such as epilepsy in an exclusive interview. He is one of the co-authors of a leading book, "Ketogenic Diets."

"I became interested while I was a child neurology trainee and saw the amazing and often sudden effect on seizures that the classic ketogenic diet could have for children," he said.

"Ketogenic diets have been around for 100 years for the treatment of epilepsy. They fell out of favor in the 1940s and 1950s when anticonvulsant drugs emerged on the market," noted the physician.

But beginning in the 1990s, these high fat diets became popular again. When should ketogenic plans be used for children with epilepsy? The decision as to when to implement this alternative approach varies.

"The ketogenic diet and modified Atkins diet are typically used when children have not responded to two drugs. However, in recent years, our center and others have started to use it first (for infantile spasms), for adults with severe epilepsy (not just children), and even as a rescue medication for status epilepticus in intensive care units," Dr. Kossoff said.

Epilepsy isn't the only condition that can potentially be helped by a low carb diet. A group of researchers have created a detailed document highlighting why restricting calories should be the first step for managing diabetes mellitus, reported Diabetes News on July 18.

The review recommends low carbohydrate diets as the first therapy for those with type 2 diabetes. For those with type 1 diabetes, low carb diets and insulin can provide more benefits than the existing low-fat diet traditionally recommended.

In contrast to the food pyramid's advice to eat grains and cut saturated fats, the diabetes researchers emphasize that increasing total fat does not increase the risk of heart disease. They also noted that following a low carb diet provides benefits regardless of whether patients lose weight, and that medication can often be decreased or even eliminated.

The potential for using a diet as an alternative to medication may provide a solution for physicians seeking an option for pregnant women with epilepsy. A new study that encompasses 20 different medical centers hopes to reduce the risks faced by some epileptic women and their children, reported the Cincinnati Enquirer on July 18.

Although most babies born to women with epilepsy are normal, the rate of anatomical birth defects is twice the average. And while eliminating anti-epilepsy medication without an alternative therapy such as a ketogenic diet is dangerous, doctors must cope with the current lack of knowledge about who will respond.

"If we could take women off these medications (to have children), we would," summed up study investigator Dr. Jennifer Cavitt, a UC associate professor of neurology. She and the other researchers plan to investigate all the different options.

"No matter what medication they're receiving, women with epilepsy should work closely with their doctors in planning pregnancy and be closely monitored during pregnancy to minimize the risk of mother and child," emphasized Dr. Michael Privitera, director of the UC Epilepsy Center. The study will last 10 years.

The National Epilepsy Foundation notes that ketogenic diets typically are used specifically for children only after their seizures have not responded to several different medications. However, as Dr. Kossoff noted, the use of such diets is beginning to spread.

Sometimes referred to as the "long-chain triglyceride diet," the ketogenic diet for epilepsy usually provides three to four grams of fat for every one gram of carbohydrate and protein. Although adhering to it may be challenging for children faced with situations celebrated with high carb food such as birthday parties, minimizing carbohydrates is an essential part of achieving ketosis.

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