Important Caution: Dietary therapy for seizures is a form of medical therapy that must be overseen by a trained medical professional. Do not undertake any type of ketogenic or Modified Atkins dietary therapy without proper medical supervision, particularly if you are taking anti-seizure medication. The articles and contents on this website are for informational purposes only. We cannot give medical advice and urge you to discuss with a neurologist the treatment options that are best for you. We cannot be held responsible if you fail to do so.
Why is dietary therapy used to treat epilepsy?
Patients who have difficult- to-treat seizures, or who have intolerable or even catastrophic reactions to medication, need non-pharmaceutical treatment options, such as dietary therapy.
There are very effective anti-seizure medications available, and most people are able to control their seizures by using them. However, there is no “magic pill” that works for everyone; it may take time to find a seizure medication and dosage that is right for you. Unfortunately some people are not able to find relief from seizures by taking medication, and fail numerous attempts.
About 30% of people are not able to control their seizures with medication. This is when Ketogenic and Modified Atkins diet therapy is most often used as a treatment option. Ketogenic and Modified Atkins dietary therapy have proven effective for patients who do not have success controlling their seizures with medication or with patients who find the side-effects of medication intolerable.
According to Dr. Eric Kossoff, of Johns Hopkins Hospital, “Despite a doubling of anticonvulsants available for the treatment of epilepsy over the past decade, there has been a growing recognition that if two or three drugs don’t work, the odds of finding a successful medicine for seizures is nearly zero. Many children, adolescents, and adults look for another answer.”
What is the Ketogenic diet?
The Ketogenic diet is a special high fat, low carbohydrate diet that is used by some people to control epileptic seizures. The diet’s name is derived from ketones, a substance formed when the body burns fat for energy, rather than glucose. It has been widely used since the 1920’s to control epilepsy, but fell into disuse for a period of time after the development of modern anti-seizure medication. A resurgence of scientific interest in the diet began in the 1990’s; since that time, numerous clinical studies have been conducted validating it as an effective treatment method, particularly when anti-epileptic medications fail. A less restrictive version of the traditional Ketogenic diet, the Modified Atkins diet, was developed in 2002.
What is the Modified Atkins diet?
The Modified Atkins diet is a variation of the traditional ketogenic diet, modeled on the Atkins weight loss diet. The diet has been modified to allow less carbohydrate than the weight loss version of the Atkins diet, and significantly more fat. It was studied by Dr. Eric Kossoff and colleagues at Johns Hopkins Hospital in 2002 and the first paper was published on the diet in 2003. Since then numerous international clinical studies have been conducted to verify the efficacy of the diet to control seizures. It is often prescribed for older children, teenagers and adults, or for those who wish for less restrictive food options than the traditional ketogenic diet allows. Foods can be eaten in restaurants and in social gatherings more easily, therefore the diet is usually more easily tolerated by adults and teenagers.
Both the traditional Ketogenic diet and the Modified Atkins diet are very high fat and very low carbohydrate. On the Modified Atkins diet, however, proteins are not as restricted, foods do not need to be weighed and measured as strictly as with the traditional Ketogenic diet, there is no calorie or fluid restriction, and no need to fast when beginning the diet. Patients can initiate the diet without hospital admittance through out-patient clinics, where they receive counseling from a trained dietician and are given instructions to follow at home. It has been suggested that the diet may be particularly useful in medical centers with limited nutritional resources or the inability to admit children regularly for traditional ketogenic diet initiation, since patients can be taught to use the diet with a minimum of supervision and guidance.
Is dietary therapy ever used as a first treatment method before anti-seizure medications are given?
The future of the Modified Atkins diet is being explored, and interest has been generated in the use of the diet as a first line therapy, particularly for some milder forms of epilepsy. It is now being used by small numbers of patients in this way, and as more physicians are trained in the method the use of it is expected to grow. However, because the diet is strict and takes commitment on the part of patients and families to follow, it is not routinely chosen as a first line therapy by most people. It is more commonly used when medication fails to adequately control seizures or when concerns arise over the side-effects of medication, or side effects prove impossible to manage.
Can dietary therapy be used while taking anti-seizure medication?
Stopping anti-seizure medication must only be done in counsel with your neurologist, usually by slowly reducing the medication over time. Many people start dietary therapy while still taking medication, and if improvement in seizure control is achieved, the neurologist may suggest a slow wean from medication. Some people can be completely weaned from medication and maintain seizure control; others use the diet in conjunction with medication in order to maintain control. Each person is different and changes in medication must be discussed with your doctor.
Are there any side effects to the Modified Atkins diet?
Some patients lose weight, but usually only those who were overweight to begin with. Most maintain adequate weight accounting for growth and age. Some children had an increase in blood cholesterol. Occasionally children have difficulty adjusting initially to the diet and feel ill or are reluctant to drink, though most adjust after a short period of time. There is an increased risk of kidney stones, so staying well hydrated is encouraged to prevent this from happening. For all of these reasons, the diet should be used with proper medical supervision.
How is the patient monitored over time while on the diet?
Blood tests to check cholesterol and lips levels, as well as urine monitoring, is usually conducted every 3 to 6 months. Attending physicians also periodically monitor the child’s height and weight. Parents are encouraged to keep seizure records to monitor the diet’s effect.
How long should someone remain on the Modified Atkins diet?
The answer to that question depends on seizure control. When someone becomes seizure free for two years on the diet, often attempts are made to slowly switch back to normal ways of eating. Many children with refractory epilepsy who found seizure control through the diet were later able to resume normal ways of eating, and have remained seizure and medication free since. A number of parents who successfully used the diet for their child have blogged about their experiences; others have started free online parental support groups and forums, where experienced members support newcomers who are learning about the diet. Such online support can be found at:
• Yahoo’s ‘Atkins Diet for Seizure Control Group’ http://health.groups.yahoo.com/group/atkins4seizures/
• Matthew’s Friends Website http://www.matthewsfriends.org/
1) The Modified Atkins Diet: A Valuable Treatment for Epilepsy in China; Kossoff, E.K, ; Healing Young Hearts Website; http://www.healingyounghearts.org/wordpress/?page_id=434
2) Ketogenic Diet; Epilepsy.com website; http://www.epilepsy.com/epilepsy/treatment_Ketogenic_diet
3) Atkins Diet FAQ’s; Matthew’s Friends website; http://site.matthewsfriends.org/
4) Modified Atkins Effectively Treats Childhood Seizures, Johns Hopkins Children’s Center website; http://www.hopkinschildrens.org/Modified-Atkins-Diet-Treats-Childhood-Seizures.aspx