Therapeutic Ketosis for Seizures

 Why be interested in this?

Overview, presented by paediatric neurologist, Dr. Elizabeth A. Thiele, in fall 2012:

Dr. Thiele is Director of the Pediatric epilepsy program at the Massachusetts General Hospital (MGH), Director of the MGH Center for Dietary Therapy of Epilepsy, and Director of the Herscot Center for Tuberous Sclerosis Complex.

Over the past couple of decades there has been resurgence in the use of nutritional ketosis for the control of seizures.

In the field of neurology, the term that came to be used is “ketogenic diet”.

Seizures are one of the problems in medicine that we do not have enough good treatments for.  Many people with seizures do not get relief from them even with up to several medications at the same time or with surgery (when an option) or any combination of other treatments.

It had been long noted that, for some people, seizures would improve during a period of starvation.  Since starvation is not something that can be kept up long term, attempts were made to try to find a way to get this benefit without actually starving.  Eating in a way that induced ketosis was found to be very helpful for some children who were not having seizure control despite other treatments.

This was used in the early part of the last century, but fell almost completely out of use in the enthusiasm about a stream of new medications that became available for seizure control over the past decades. Unfortunately, despite all the combinations of all the medications, along with surgical options, many people were still (and still are today) left greatly burdened by their seizures.

In desperation, some children were started on a ketogenic diet.  Many found great benefit.  Not all children get benefit from a ketogenic diet, and the benefits are less for some and more for others.  Some children with certain inborn problems with their metabolism absolutely should not be on a ketogenic diet.  Given the lack of better options, though, the re-emergence of the therapeutic use of ketogenic diets in epilepsy has been an important breakthrough in the treatment of epilepsy.  Its use has grown widely over the past couple of decades.  Today, there are a few variations in the diet and adults are now receiving benefit from this treatment.

This success means that now there is growing interest in the possibility that the use of ketogenic diets might be helpful in other neurological conditions, such as Parkinson’s Disease, Alzheimer’s Disease and migraine.

The term “ketogenic diet” just means eating in a way that induces nutritional ketosis.  It is implied that this will be continued over some time, which then means that the person would become adapted to using ketones for a portion of their brain’s fuel needs, which is part of what we refer to as “keto-adaptation”.

Because the term “ketogenic diet” was used over decades by neurologists to describe a highly structured, very strict and specific version of an eating plan for inducing ketosis, this means that, in the field of neurology, when the term “ketogenic diet” is used, what they are referring to is this one specific approach.  These diet plans are calculated to give specific ratios of fat to protein+carbs, specific calories, defined and rigid fat, protein and carbohydrate intakes per meal and per snack and, originally, defined fluid intake limits.  Everything is weighed on a gram scale or measured, to set plans for each meal.  Sometimes this is referred to as the “classic” or “traditional” ketogenic diet.

By habit, neurologists do not use the term “ketogenic diet” to refer to less formal eating plans that also induce some degree of nutritional ketosis, such as the classic induction phase (strictest version) of the Atkins Diet.  One of the variations of dietary treatment now offered for epilepsy, especially for teens and adults, is what the neurologists refer to as “Modified Atkins Diet” which is very similar to the Atkins Induction Diet, but some modifications, such as more emphasis on fat and less emphasis on protein.

We really need new terminology to allow better communication on this topic.  People from different backgrounds use the terms in different ways and often have little exposure to or awareness of the use of nutritional ketosis outside of their own fields.

Technically, a “ketogenic diet” should be considered to be any diet that results in blood ketones levels above the very small amount that is generally present in people’s blood anyway, especially when they haven’t eaten in a while, such as overnight (often a first morning specimen of urine will show slight ketones on a test strip, reflecting this).  We need some agreed-upon terminology to communicate different degrees of ketosis and different dietary patterns employed.

In the videos below, Dr.Elizabeth Donner focuses on the classic Ketogenic Diet as used in neurology.  As well, in the same group, there are videos of other presentations at the same event, held in Toronto, March 2010, including one on the “Modified Atkins Diet”, which is the version that would usually be used for a teen or adult with epilepsy.  On YouTube search on “Ketogenic Therapy Toronto Seminar”.

NOTE: There seems to be some technical issues with this particular video.  If the video is not visible, my apologies. It will come up right away if you go to YouTube and search “Elizabeth Donner Ketogenic”.

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Some Resources:

Mathews Friends, a major source of information, UK   http://www.matthewsfriends.org

The Charlie Foundation, also a major source of info, USA  http://www.charliefoundation.org

Epilepsy Foundation, at epilepsy.org  LINK to resource pages re: dietary therapy

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A brief, 2:30 minute YouTube video (in comments on YouTube, see mother’s report that 4 years later Cady is now off the diet and seizure-free)

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Another YouTube video related to the use of Ketogenic Diet at Mayo Clinic

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Medical paper on ketogenic diet and epilepsy

Ketone bodies in epilepsy.

McNally MA, Hartman AL.

J Neurochem. 2012 Apr;121(1):28-35. doi: 10.1111/j.1471-4159.2012.07670.x. Review.

PMID: 22268909