When a child with epilepsy hasn’t responded to two anti-seizure medications and isn’t a candidate for epilepsy surgery, there’s a third option to consider — a ketogenic diet.
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What is this diet? Think high-fat, low-carb. “It’s based on a ratio of fat to carbohydrates and proteins,” says board-certified epileptologist Ahsan Moosa Naduvil Valappil, MD. “A normal diet contains a 0.3:1 fat-to-carb and protein ratio, but the classical ketogenic diet is based on a 3 or 4:1 ratio.”
The diet maintains a stable, low-normal level of glucose and higher levels of ketones (derived from fat metabolism) in the body, forcing the brain to draw its energy from fat instead of sugar.
While little is known about how it works, it has been found to considerably reduce the frequency of seizures in as much as 50 percent of children with difficult to control epilepsy.
4 things parents should know about the ketogenic diet
Think it might be right for your child? Here are four things Dr. Naduvil says you should know.
1. Don’t try it on your own. Children who may benefit from this diet need to be carefully chosen. The ketogenic diet may not be safe in children with certain rare metabolic disorders. Children beginning the ketogenic diet are admitted to the hospital and frequently undergo a period of fasting. The child’s glucose levels are closely monitored as the diet is gradually introduced, and the child typically stays four to five days before going home with detailed dietary instructions.
2. Implementing the diet: not easy, but doable. “Strict compliance is needed for best results”, says Dr. Naduvil. His team of physicians, dieticians and nurses continue to work closely with families at home, using password-protected websites like Ketocal.com to calculate the right ratios and find appropriate recipes.
3. Have realistic expectations. “The ketogenic diet is not a cure for epilepsy,” says Dr. Naduvil, adding that though reduction is seizures is common, sustained complete freedom from seizures occurs only rarely. A 2008 clinical trial conducted by the Institute of Child Health in London found that after three months on the ketogenic diet, 38 percent of children with epilepsy achieved a 50 percent or more reduction in seizures, and 7 percent had a 90 percent seizure reduction.
4. Other benefits may occur. “Many parents will say that their child is more alert and active while on the diet,” says Dr. Naduvil. “They may continue with the diet for that reason even if there’s no reduction in seizures.”