Treating The Brain-Injured
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Stanford Medical Center
Ketogenic Diet Program
Gabriel's Ketogenic Diet Information
Another Approach To Seizures
By Phillip L. Pearl, M.D.
Clinical Assistant Professor of Pediatrics &Neurology at the Schools of Medicine at Georgetown University, George Washington University, and the University of Maryland
One of the most vexing problems for children with tuberous sclerosis is the realization of seizure control without the side-effects of medications. Most parents are very familiar with many of the anti-seizure medications, and the downside associated with many of them from nuisance of blood tests to side effects that may range from temporary headaches or nausea to liver failure and occasional death.
Physicians have long sought the ideal anti-seizure drug treatment which would be highly effective without serious, adverse, acute or long-term effects. While many of the traditional and longstanding anti-epileptic drugs (Phenobarbital, Phenytoin [Dilantin], Carbamazepine [ Tegretol], Valproate [Depakote, Depakene], Primidone [Mysoline], Clonazepam [Klonopin]) were based more on serendipity and fortuitous discoveries, researchers are now working hard to develop tailor made drugs to treat specific kinds of seizures. Since the 1993 introduction of Felbamate (Felbatol), touted as a miracle drug, but later found to have possible severe side-effects, new drugs have entered the scene including Gabapentin (Neurotin) and Lamotrigine (Lamictal) in 1994, Phosphenytoin (Cerebyx) in 1996, and Topiramate (Topamax) in 1997.
Among the sea of medications, one non-drug treatment has received much attention recently: the Ketogenic Diet, a therapeutic diet high in fat and low in protein and carbohydrates. The diet represents an alternative to pharmaceutical therapies and has been widely publicized, particularly in the Feb. 16,1997 ABC airing of "First Do No Harm," a movie produced by Jim Abrahams, whose own son, Charlie, benefitted from the epilepsy diet.
This diet, however, is not new. The modern diet was devised in the 1920s in an attempt to reproduce metabolic effects of starvation for seizure control. While the mechanism of this diet remains poorly understood, it appears that both fasting and acidosis have protective effects against seizures. A key part of the diet is restricting the availability of glucose, the central nervous system's main metabolic fuel, to the brain.
Specifically, the Ketogenic Diet involves a high fat, low calorie diet which allows the body to transfer to a metabolism utilizing ketones, a product of fat breakdown, instead of glucose as a brain fuel. The diet, which has been traditionally used in young children, is designed to meet the needs of each individual and is guided by a specific ratio by weight of fat to protein and carbohydrate with the calories set at the child's growth requirement. It is very heavy on cream and butter and highly restrictive of sugar, and it is very important that vitamin, mineral, and calcium supplements are added. Some versions utilize MCT (medium chain triglyceride) oil.
Most clinical reports have documented that 1/2 to 2/3 of patients have improved seizure control on the Ketogenic Diet, with 1/3 of the patients having a dramatic decrease in seizures. Many of the patients are able to reduce if not completely discontinue their anti-epileptic medications. Benefits sometimes also include increased alertness and improved behavior. Complications and side effects include refusal to eat, kidney stones, dehydration, diarrhea or constipation. In many ways, the Ketogenic Diet is best viewed as another medical therapy, like a drug, to control seizures.
To see a sample menu of the Ketogenic Diet, go to Ketongenic Diet Menus. To find out more about Dr. Pearl, go to the Clinic Staff Page.
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