Created: Monday, November 12, 2007

A recent Carte Blanche programme featured the use of the controversial ketogenic diet in the treatment of intractable epilepsy in children.

Intractable epilepsy - of which Lennox-Gastaut is a prime example - refers to a type of epilepsy that doesn't respond to anti-epilepsy medication. In children who suffer from Lennox-Gastaut epilepsy, the use of the ketogenic diet is often the last resort to keep the child from suffering multiple seizures every day.

But the diet can be both dangerous and difficult to maintain.

What does the diet entail?
The ketogenic diet involves inducing a state of ketosis in the child by reducing carbohydrate intake drastically and increasing the intake of fats and proteins to compensate for the lack of carbohydrates.

The diet forces the body to burn fats for energy (nearly 80% of the diet's energy is derived from fat) - a process which produces chemicals called ketones.

For some reason that is not yet fully understood, the ketones that circulate in the body help to suppress epileptic seizures (Krause, 2000; Epilepsy Foundation, 2007). It's possible that ketones act like inhibitors of neurotransmission that prevents seizures (Krause, 2000).

However, the diet is not successful in all cases. About 30% of children with severe seizures will respond fully to the ketogenic diet, while 30% will experience a decrease in seizures, and 30% will not respond. We also don't yet know why the diet works for some children and not for others (Krause, 2000).

Initial ketosis is induced in children by starvation for 24 to 72 hours. During this period the child is usually hospitalised. Once a satisfactory state of ketosis has been achieved, the child is given the high-fat, high-protein diet.

There are two versions of the ketogenic diet: the older version, which reduces carbohydrate intake to a minimum, and a more recent version that makes use of medium-chain triglycerides (MCTs) to provide the high fat intake.

The latter diet is probably easier to apply because it allows small quantities of fruit and vegetables and doesn't require such strict attention to liquid intake. When the older ketogenic diet is used, the child must be partially dehydrated to ensure that the circulating ketones are not diluted. With the MCT diet, liquid restriction is less severe (Krause, 2000).

Important things to remember
The following vital points must be kept in mind when considering or applying the ketogenic diet:

Side effects of the ketogenic diet
The ketogenic diet can have a variety of side effects, including:

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Epilepsy & nutrition