A pilot trial with modified Atkins’ diet in adult patients with refractory epilepsy (original) (raw)
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The ketogenic and atkins diets effect on intractable epilepsy: a comparison
Iranian journal of child neurology, 2014
Intractable epilepsy is a major difficulty in child neurology, because the numbers of drugs that are available for treatment are limited and new treatments such as diets must be tried. Now there are some diets available for treating patients with intractable epilepsy. The oldest diet is the classic ketogenic diet and one of the newest diets is the modified Atkins diet. Patients have a harder time accepting the classic ketogenic diet than the Atkins diet, which is easier to accept because the food tastes better. This study compares the efficacy of the ketogenic diet and the Atkins diet for intractable epilepsy in children. This study is a clinical trial survey with sample size of 40 children with refractory epilepsy who were patients at Mofid hospital in Tehran, Iran. Initially, from Jan 2005-Oct 2007, 20 children were treated with the Atkins diet, and then from Oct 2007-March 2010, the other group was treated with the classic ketogenic diet and the results were compared. In this stu...
The Effectiveness of Ketogenic Diet in Treatment of Epilepsy Patients: A Literature Review
International Journal of Nursing and Health Services (IJNHS)
The ketogenic diet is one of the alternative treatment management of epilepsy patients. The study aimed to examine the effect of the ketogenic diet for managing the epilepsy patients. A literature review used by databases to find the relevant articles included Science Direct, Scopus, and Pro-Quest from 2011 to 2018. Metabolic therapy with the ketogenic diet can improve mitochondrial function, increase inhibition, and reduce nerve stimulation, which can cause seizures in epilepsy patients. Also, other factors need to be considered to produce an optimal impact on the use of the ketogenic diet, such as patient compliance and age. The ketogenic diet is one of the non-pharmacological alternatives that can be done to prevent recurrence in epilepsy patients. Keywords: ketogenic diet, epilepsy, literature review
Ketogenic Diet and Epilepsy: What We Know So Far
Frontiers in Neuroscience
The Ketogenic Diet (KD) is a modality of treatment used since the 1920s as a treatment for intractable epilepsy. It has been proposed as a dietary treatment that would produce similar benefits to fasting, which is already recorded in the Hippocratic collection. The KD has a high fat content (90%) and low protein and carbohydrate. Evidence shows that KD and its variants are a good alternative for non-surgical pharmacoresistant patients with epilepsy of any age, taking into account that the type of diet should be designed individually and that less-restrictive and more-palatable diets are usually better options for adults and adolescents. This review discusses the KD, including the possible mechanisms of action, applicability, side effects, and evidence for its efficacy, and for the more-palatable diets such as the Modified Atkins Diet (MAD) and the Low Glycemic Index Diet (LGID) in children and adults.
Intractable Seizure Disorders: Efficacy of the Classic Ketogenic Diet
Iranian Journal of Child Neurology, 2009
The ketogenic diet is a high-fat, low carbohydrate, adequate protein diet, developed in the 1920s for the management of intractable seizure disorders in children. To evaluate efficacy and tolerability of the classic ketogenic diet, we analyzed records of the children started on the diet from 1999 to 2006 at the Mofid children's hospital.
Epilepsy & Behavior, 2012
The ketogenic diet (KD) is a high-fat, low-protein, low-carbohydrate diet that is used as a treatment for patients with difficult-to-control epilepsy. The present study assesses the efficacy and tolerability of the KD as an add-on therapy in adults with chronic refractory epilepsy. 15 adults were treated with the classical diet or MCT diet. During a follow-up period of 1 year we assessed seizure frequency, seizure severity, tolerability, cognitive performance, mood and quality of life (QOL). We found a significant reduction in seizures among the patients who followed the diet at least 1 year (n = 5). Of these 5 patients, 2 had a reduction between 50 and 90%. Analyzing the study months separately, we found a seizure reduction of ≥ 50% in 26.6% of the patients during at least 1 month of treatment. Common side-effects were gastrointestinal disorders, loss of weight and fatigue. There was a considerable, non-significant improvement found in mood and QOL scores. Improvements were independent of reduction in seizure frequency, indicating that the effects of the KD reach further than seizure control.
Ketogenic diet (KD) therapy is an established form of treatment for both pediatric and adult patients with intractable epilepsy. Ketogenic diet is a term that refers to any diet therapy in which dietary composition would be expected to result in a ketogenic state of human metabolism. While historically considered a last-resort therapy, classic KDs and their modified counterparts, including the modified Atkins diet and low glycemic index treatment, are gaining ground for use across the spectrum of seizure disorders. Registered dietitian nutritionists are often the first line and the most influential team members when it comes to treating those on KD therapy. This paper offers registered dietitian nutritionists insight into the history of KD therapy, an overview of the various diets, and a brief review of the literature with regard to efficacy; provides basic guidelines for practical implementation and coordination of care across multiple health care and community settings; and describes the role of registered dietitian nutritionists in achieving successful KD therapy.
Seizure, 2009
Approximately 30% of patients with epilepsy have refractory epilepsy, i.e. seizures persist despite accurate diagnosis and carefully monitored treatment with antiepileptic (AEDs) drugs. 1,2 The ketogenic diet (KD) is a high-fat, adequate-protein and very low-carbohydrate diet that has been used for many years to treat intractable epilepsy in children. The KD has been shown to be effective in retrospective, prospective and randomized controlled studies. 3-6 In a randomized controlled trial, after 3 months of the KD, 38% of patients had >50% seizure reduction compared with 6% of the controls, while 7% of patients had >90% seizure reduction compared with none of the controls. 5 In Korean and American multicentric studies, more than 40-50% of patients had a >50% reduction in seizure frequency after 6 and 12 months. 6,7 More recently, the modified Atkins diet has been used to treat intractable epilepsy. 8-13 The modified Atkins diet induces ketosis without fluid, calorie or protein restriction, nor the requirement for fasting or food weighting. Daily carbohydrates are limited and high-fat intake encouraged. The modified Atkins diet was designed to be a less restrictive alternative than the KD. Early studies have suggested efficacy and safety in both children and adults. 8-13 The mechanisms by which the KD and modified Atkins diet exert their anti-seizure effects are not clear. Among the possible mechanisms of action, it has been hypothesized that various fatty acids, by influencing neuronal excitability, may constitute part of beneficial effects of KD on seizure control. 14-21 In a study of 9 children on KD, elevated blood polyunsaturated fatty acid (PUFA) was found. The rise in arachidonic acid (AA) was correlated with seizure control. 22 However, a decrease in serum AA and an increase of linoleic (LA) and eicosapentaenoic (EPA) acids were found in another study including 25 patients. 23 In the latter, no correlation between serum fatty acids levels and seizure control was found. We report our experience using both classic KD and modified Atkins diet in children with refractory epilepsy. Our aim was to compare the relative efficacy of the diets and to evaluate serum long chain fatty acids profiles.
Efficacy of the ketogenic diet in focal versus generalized seizures
Pediatric Neurology, 2001
Most reports of the ketogenic diet have focused on its efficacy for generalized seizures. Few data are available regarding its effect on focal seizures. We retrospectively studied patients (mean ؍ 7.5 years of age) with medically intractable epilepsy treated by the ketogenic diet. The predominant seizure types in each patient were classified as generalized (100 patients) or focal (34 patients) based on ictal electroencephalograms (EEGs) or seizure semiology and interictal EEG. A seizure reduction of more than 50% compared with baseline was seen in nine patients (27%) with focal seizures and 46 patients (46%) with generalized seizures at 3 months, in 10 patients (30%) with focal seizures and 46 patients (46%) with generalized seizures at 6 months, and in eight patients (24%) with focal seizures and 42 patients (42%) with generalized seizures at 12 months. Differences were not significant. Outcome tended to be better in patients younger than 12 years of age compared with the older age group, but the difference was significant at 6 months only. Our results suggest that some patients with intractable focal epilepsy may respond favorably to the ketogenic diet and that this option should be considered if epilepsy surgery is not possible.