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Epilepsy and diet

 The Ketogenic Diet
The ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. It is prescribed by a physician. It is not the same as other popular low-carbohydrate diets, such as the Atkins diet.
The name ketogenic means that it produces ketones in the body (keto = ketone, genic = producing). Ketones are formed when the body uses fat for its source of energy. Usually the body usually uses carbohydrates (such as sugar, bread, pasta) for its fuel, but because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead. Ketones are not dangerous. They can be detected in the urine.
Who will it help?

Doctors usually recommend the ketogenic diet for children whose seizures have not responded to several different seizure medicines. It is particularly recommended for children with the Lennox-Gastaut syndrome.

Doctors seldom recommend the ketogenic diet for adults. When it has been tried with adults, it doesn't seem to work nearly as well. The reasons for this difference are unclear.

What is it like? The typical ketogenic diet, called the "long-chain triglyceride diet," provides 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. The dietician recommends a daily diet that contains 75 to 100 calories for every kilogram (2.2 pounds) of body weight and 1-2 grams of protein for every kilogram of body weight. If this sounds complicated, it is! That's why parents need a dietician's help.

The kinds of foods that provide fat for the ketogenic diet are butter, cream, mayonnaise, and peanut butter. Because the amount of carbohydrate and protein in the diet have to be restricted, it is very important that the meals be prepared carefully. No other sources of carbohydrates can be eaten. (Even toothpaste might have some sugar in it!). For this reason, the ketogenic diet is supervised by a dietician. The parents and the child become very familiar with what can and cannot be eaten.

What happens first? Typically the diet is started in the hospital. The child usually begins by fasting (except for water) under close medical supervision for 38 hours (24 hours for infants). For instance, the child might go into the hospital on Monday, start fasting at 6 p.m. and continue to have only water until 8 a.m. on Wednesday. Then the child's urine is tested to see if it shows ketones. If ketones are found, the diet is then begun. The child stays in the hospital for another 2 to 3 days for close monitoring. During this time, the parents are taught more about the diet.

Does it work? Several studies have shown that the ketogenic diet does reduce or prevent seizures in many children whose seizures could not be controlled by medications. Over half of children who go on the diet have at least a 50% reduction in the number of their seizures. Some children even become seizure-free.

Children who are on the ketogenic diet continue to take seizure medicines. Some are able to take smaller doses or fewer medicines than before they started the diet, however.

It is not clear how the diet works, though doctors have some theories. What is clear is that it must be followed precisely. If the person goes off the diet for even one meal, it loses its good effect. So it is very important to stick with the diet as prescribed. It can be especially hard to follow the diet 100% if there are other children at home who are on a normal diet. Small children who have free access to the refrigerator are tempted by "forbidden" foods. Parents need to work as closely as possible with a dietician.

Are there any side effects? A person starting the ketogenic diet may feel sluggish for a few days after the diet is started. This can continue if the patient takes phenobarbital or benzodiazepines.

Other side effects that might occur if the person stays on the diet for a long time are:

* thinning of bone
* kidney stones
* abnormal liver function
* hair thinning
* high cholesterol levels in the blood
* dehydration
* constipation
* changes in behavior
* slowed growth
Because the diet does not provide all the vitamins and minerals found in a balanced diet, the dietician will recommend vitamin and mineral supplements. The most important of these are calcium and vitamin D (to prevent thinning of the bones), iron, and folic acid.

To avoid complications, the seizure medicines Topamax (topiramate) and Diamox (acetazolamide) must be stopped before the diet is started.

How is the patient monitored over time? Early on, the doctor will usually see the child every month. Blood tests are performed to make sure there are no medical problems. The height, weight and head size are measured to see if growth has slowed down. As the child gains weight, the diet must be adjusted by the dietician.

Can the diet ever be stopped? If seizures have been well controlled for some time, the doctor might suggest going off the diet. Usually, the patient is gradually taken off the diet over several months or even longer. Just as happens if seizure medicines are stopped suddenly, seizures may become much worse if the ketogenic diet is stopped all at once. Children usually continue to take seizure medicines after they go off the diet.

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