Dietary and Medication Adjustments to Improve Seizure Control in Patients Treated With the Ketogenic Diet

Abstract

Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007 to 2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments led to >50% further seizure reduction in 18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs 15%, P = .08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit).

Keywords

diet ketosis ketogenic anticonvulsants epilepsy

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References

Kossoff

Zupec-Kania

Rho

. Ketogenic diets: an update for child neurologists. J Child Neurol. 2009;24:979–988.

Neal

Chaffe

Schwartz

. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008;7:500–506.

Freeman

Kossoff

Hartman

. The ketogenic diet: one decade later. Pediatrics. 2007;119:535–543.

Kossoff

Zupec-Kania

Amark

. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009;50:304–317.

Kossoff

Freeman

Turner

Rubenstein

. Ketogenic Diets: Treatments for Epilepsy and Other Disorders. New York: Demos Medical Publishing; 2011.

Seo

Lee

. Efficacy and tolerability of the ketogenic diet according to lipid : nonlipid ratios—comparison of 3:1 with 4:1 diet. Epilepsia. 2007;48:801–805.

Hamdy

Turner

Pyzik

Kossoff

. Lack of influence of body mass index on the efficacy of the ketogenic diet. J Child Neurol. 2007;22:1167–1171.

Evangeliou

Spilioti

Doulioglou

. Branched chain amino acids as adjunctive therapy to ketogenic diet in epilepsy: pilot study and hypothesis. J Child Neurol. 2009;24:1268–1272.

Hartman

Rubenstein

Kossoff

. Intermittent fasting: a “new” historical strategy for controlling seizures? Epilepsy Res. 2013;104:275–279.

10.

Huttenlocher

. Ketonemia and seizures: metabolic and anticonvulsant effects of two ketogenic diets in childhood epilepsy. Pediatr Res. 1976;10(5):536–540.

11.

Kossoff

Cervenka

Henry

. A decade of the Modified Atkins Diet (2003-2013): results, insights, and future directions. Epilepsy Behav. 2013;29:437–442.

12.

Pfeifer

Lyczkowski

Thiele

. Low glycemic index treatment: implementation and new insights into efficacy. Epilepsia. 2008;49(suppl 8):42–45.

13.

Kossoff

Nabbout

. Use of dietary therapy for status epilepticus. J Child Neurol. 2013;28:1049–1051.

14.

Kossoff

Laux

Blackford

. When do seizures usually improve with the ketogenic diet? Epilepsia. 2008;49:329–333.

15.

Farasat

Kossoff

Pillas

. The importance of parental expectations of cognitive improvement for their children with epilepsy prior to starting the ketogenic diet. Epilepsy Behav. 2006;8:406–410.

16.

Morrison

Pyzik

Hamdy

. The influence of concurrent anticonvulsants on the efficacy of the ketogenic diet. Epilepsia. 2009;50:1999–2001.

17.

Veech

. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids. 2004;70:309–319.

18.

Hancock

Cross

. Treatment of Lennox-Gastaut syndrome. Cochrane Database Syst Rev. 2013;2:CD003277.