Medscape article for those dealing with seizures

[Guest guest]

Ketogenic and Atkins Diets Effective in Absence Epilepsy

Gandey

September 8, 2010 — Two high-fat diets — the classic ketogenic and a

modified version of the Atkins — can be useful in difficult-to-treat absence

epilepsy, report researchers.

" We already knew these diets worked well for several other types of

epilepsy, but our new findings bring more good news — children with absence

epilepsy who don't respond to anti-seizure medications can also benefit from

these dietary approaches, " senior investigator Kossoff, MD, a pediatric

neurologist and director of the ketogenic diet program at s Hopkins

Children's Center, Baltimore, land, said in a news release.

The new study will appear in an upcoming issue of Child Neurology but was

released early online.

The ketogenic diet provides just enough protein for body growth and repair

and sufficient calories to maintain a healthy weight. The diet contains a

4:1 ratio of fat to combined protein and carbohydrate.

The modified Atkins diet is a less restrictive option and reportedly

induces ketosis without restricting calories, fluids, or protein. It is

increasingly used for adolescents and adults not typically offered the

traditional

ketogenic diet.

To assess the dietary therapies for childhood and juvenile absence

epilepsy, investigators studied patients treated at s Hopkins and conducted

a

historical literature review.

The research team evaluated 21 absence-epilepsy patients at Hopkins who

were treated with either the ketogenic or the modified Atkins diet.

The median age of seizure onset was 4.5 years, and the median age at diet

start was 6 years. The median number of anticonvulsants tried was 4, and the

median number of anticonvulsants used at the time of diet onset was 1.

Table. Seizure Reduction in s Hopkins Patients Seizure Reduction

At 1 Month, % At 3 Months, % >50% 76 82 >90% 38 48 Seizure free 19 19

Investigators reviewed 17 published studies in which absence epilepsy was

included as a patient subpopulation. In total, 133 patients had clear

outcomes. The researchers compared the outcomes from the literature to the

3-month seizure reduction of patients at Hopkins.

" There was a slightly higher rate in our subjects of a greater than 50%

seizure reduction, 82% vs 69%, " Dr. Kossoff reports. " Interestingly, there was

a similar but negative trend regarding likelihood of seizure freedom, 19%

vs 34%. "

The investigators point out there were no patient demographics that

predicted who was more likely to respond to dietary treatment. Larger

prospective

studies with documented prediet electroencephalography and larger sample

sizes for those treated with particular concurrent anticonvulsants could

demonstrate predictive factors, they suggest.

There is insufficient class I evidence to recommend the ketogenic diet as

a first-line intervention.

" Our center's experience appears to be similar to those published for the

past 87 years, even acknowledging that some of the patients reported in the

literature might not have had classic childhood or juvenile absence

epilepsy, " the researchers point out.

In the spring, Dr. Kossoff published another study showing the ketogenic

diet is effective in patients with _infantile spasms_

(http://www.medscape.com/viewarticle/722620) (Epilepsia. Published online

April 30, 2010).

Earlier this month, the Infantile Spasms Working Group released _new

guidelines_ (http://www.medscape.com/viewarticle/728046) that backed the

ketogenic diet as a second line therapy. " The ketogenic diet may be an option

in

drug-resistant epilepsy as an adjunct to pharmacologic therapy, " reported the

group led by Pellock, MD, from the Virginia Commonwealth University

School of Medicine in Richmond. " Currently, " the guideline authors note,

" there is insufficient class I evidence to recommend the ketogenic diet as a

first-line intervention. "

This study was funded by the Carson Foundation, the National

Institutes of Health, the Dr. C. and Atkins Foundation, and

Nutricia Inc. Dr. Kossoff has received funding from Nutricia and Atkins

Nutritionals.

J Child Neurol. Published online July 20, 2010.

Medscape Medical News © 2010 WebMD, LLC