Approximately 60-65% of patients with epilepsy become seizure free with antiepileptic drug treatment. The remaining 35% are resistant to medications. However, a review of current research published in Neurology presents a promising alternative treatment for epileptic seizure reduction - diets high in fats and low in carbohydrates.
Researchers aimed to review the high-fat, low-carbohydrate ketogenic and modified Atkins diets for the treatment of refractory epilepsy (drug-resistant epilepsy) in adults. Both diets have proved successful in children, yet they are studied in adults insufficiently.
The modified Atkins diet and the ketogenic diet include high-fat foods such as bacon, eggs, mayonnaise, butter, hamburgers and heavy cream, with certain fruits, vegetables, nuts, avocados, cheeses and fish.
The ketogenic diet is restrictive, not very palatable and logistically difficult to execute. The Atkins diet has been modified for use in patients with tough-to-treat epilepsy as an easier-to-execute variety of the ketogenic diet.
The ratios of fat to carbohydrate and protein are as follows:
- Ketogenic diet: 3:1 or 4:1 [fat]:[carbohydrate 1 protein] ratio by weight, with 87-90% of calories derived from fat
- Modified Atkins diet: 0.9:1 [fat]:[carbohydrate 1 protein] weight ratio, with approximately 50% of calories derived from fat.
By contrast, the typical American diet derives about 50% of calories from carbohydrate, 35% from fat and 15% from protein. US governmental guidelines for adults recommend 45-65% calories from carbohydrates, 10-20% from fat and 10-35% from protein.
Study author Pavel Klein, MB BChir, of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, MD, and a member of the American Academy of Neurology, says:
"We need new treatments for the 35% of people with epilepsy whose seizures are not stopped by medications. The ketogenic diet is often used in children, but little research has been done on how effective it is in adults."
The scientists examined five studies of ketogenic diet treatment in 47 adults and five studies of modified Atkins diet treatment in 85 adults with refractory epilepsy.
Some patients achieved 50% or greater seizure reduction
Across all studies, 32% of ketogenic diet-treated patients and 29% of modified Atkins diet-treated patients achieved 50% or greater seizure reduction. Also, 9% of the ketogenic diet and 5% of the modified Atkins diet-treated patients achieved greater than 90% seizure reduction.
- Epilepsy is a chronic neurological condition characterized by recurrent seizures
- Epilepsy affects about 2.3 million adults and 467,711 children 0-17 years of age in the US
- About 1 in 26 people will be diagnosed with epilepsy at some point in their lives
- About 150,000 new cases of epilepsy will be diagnosed in the US each year.
The positive effect on seizures occurred quickly with both diets, within days to weeks. The results persisted long term, but unlike in children, the effects appear not to last after discontinuation of the diet.
The side effects of both diets were similar and not severe. Hyperlipidemia, the most serious, reversed after treatment discontinuation, and weight loss was the most common side effect.
Klein comments, "Unfortunately, long-term use of these diets is low because they are so limited and complicated. Most people eventually stop the diet because of the culinary and social restrictions."
"However, these studies show the diets are moderately to very effective as another option for people with epilepsy," he adds.
In both the ketogenic diet and modified Atkins diet studies, retention was poor with 51% of ketogenic diet-treated and 42% of modified Atkins diet-treated patients ending the diet before study completion. Even those with 75-100% seizure frequency reduction eventually stop the diet due to culinary and social restrictions.
The authors conclude that for treatment of refractory epilepsy, current data do not provide an evidential basis for the ketogenic diet and modified Atkins diet use. Until more data are available, they should only be used as a last resort.
Ketogenic diet and modified Atkins diet treatment show moderate effectiveness, but in some patients, the effect is remarkable.
Medical News Today recently reported omega-3 fish oil could reduce seizure frequency for epilepsy patients. A study claims epilepsy patients could reduce seizure frequency by consuming low doses of omega-3 fish oil every day.