Lancet Neurology press release
A randomised controlled trial has confirmed the efficacy of the
ketogenic diet in helping control and prevent epileptic seizures in
children with drug-resistant epilepsy. These are the conclusions of
authors of an Article published early Online and in the June edition of
The Lancet Neurology.
The ketogenic diet has been used widely and
successfully to treat children with drug-resistant epilepsy since the
1920s. It is a diet very high in fat, low in carbohydrate and with
controlled protein. Although the exact mechanism of action is still
unclear, the high fat and restricted carbohydrate content of the diet is
thought to mimic the biochemical response to starvation, when ketone
bodies*, rather than sugars, become the main fuel for the brain’s energy
demands. While there have been many observational studies of this diet,
Professor J Helen Cross, Institute of Child Health and Great Ormond
Street Hospital for Children NHS Trust, University College London, UK, and colleagues have done the first randomised controlled trial to test its efficacy.
The
trial assessed 145 children aged between 2 and 16 years who had at
least daily seizures (or more than seven seizures per week), had failed
to respond to at least to antiepileptic drugs, and had not been treated
previously with the ketogenic diet. Enrolment for the study took place
between 2001 and 2006, and children were seen at one of two hospital
centres or a residential centre for young people with epilepsy. All
children had their baseline seizure levels recorded over a four week
period. Following this, 73 were assigned to the ketogenic diet
immediately, and 72 were assigned to the diet after a delay of three
months – both groups had no other changes to treatment. The delay group
acted as the control group during the three month delay.
The
researchers obtained complete data for 54 children in the diet group and
49 in the control group. Using the baseline figures as 100%, they found
that the number of seizures the diet group dropped by more than a third
(62% of seizures recorded compared with baseline), while the control
group saw their seizures rise by more than a third (136.9% of seizures
compared with baseline). 28 of the 54 children who completed the three
months in the diet group had greater than 50% seizure reduction compared
with just four of 49 children in the control group. Five children in
the diet group saw a seizure reduction of above 90%, compared to none in
the control group. The most frequent side-effects reported at three
months were constipation, vomiting, lack of energy, and hunger.
The
authors say: “We have shown that the diet has efficacy and should be
included in the management of children who have drug-resistant epilepsy.
However, the diet is not without possible side-effects, which should be
considered alongside the risk benefit of other treatments when planning
the management of such children.”
They add: “In view of this we
believe that the diet should be more widely available as a treatment on
the NHS, for children with epilepsy, who have failed to respond to
anticonvulsant medication. We stress this is a diet which should only
be undertaken on medical advice and under medical and dietetic
supervision.”**
In an accompanying Reflection and Reaction
comment, Dr Max Wiznitzer, Rainbow Babies and Children’s Hospital,
Cleveland, OH, USA, says that more information is needed about the
long-term effects of the ketogenic diet, including changes in blood fat
concentrations and persistent ketosis. He adds: “Better identification
of epilepsies that benefit from starting early on the ketogenic diet and
comparisons between the choices of ketogenic diet are needed.”
Notes
to editors: *Ketone bodies are water soluble compounds that are
produced as by products when fatty acids are broken down for energy in
the liver and kidneys. They are used as a source of energy in the heart
and brain. In the brain, they are a vital source of energy during
fasting.
**This second quote from the authors is their opinion and cannot be found within the Article
Professor
J Helen Cross, Institute of Child Health and Great Ormond Street
Hospital for Children NHS Trust, University College London, UK, please
contact Communications, Great Ormond Street Hospital T) +44 (0) 20 7239
3119 E) coxs@gosh.nhs.uk / BarbeJ@gosh.nhs.uk
Contact information:
GOSH-ICH Press Office: 020 7239 3125
Email: Coxs@gosh.nhs.uk
For genuine and urgent out of hours call speak to switchboard on 020 7405 9200
