Medications are the initial treatment choice for almost all patients with multiple seizures. Some patients who only have a single seizure and whose tests do not indicate a high likelihood of seizure recurrence may not need medications. Medications are highly effective and completely control seizures in the majority (approximately 70%) of patients. With approximately twenty different antiepileptic drugs currently available, and more likely to be available in the near future, choosing the right medication for an individual patient has become complicated.
Choice of medication depends on a variety of factors, some of which include the type of seizure and epilepsy, likely side effects of the medication, other medical conditions in the patient that may be improved or worsened by the medication, potential for interactions with the patient’s other medications, age, gender, and cost of the medication. Our adult and pediatric epileptologists have the knowledge and experience of utilizing all available antiepileptic medications. They also have the expertise to know when to treat patients, and how to choose the most appropriate medication.
The remaining 30% of patients whose seizures are poorly controlled with two or more medications are considered to have refractory or intractable epilepsy. Apart from additional trials of antiepileptic medications singly or in combination, currently available treatment options for these patients include surgery, vagus nerve stimulation, and dietary therapy.
What is the ketogenic diet?
The ketogenic diet is a special high-fat diet that is used to treat seizures. Whipping cream, fats, and vegetable oils are used to provide the necessary fat. The diet eliminates foods such as sweets, bread, cereal, pasta, and milk. All foods must be carefully prepared and weighed on a gram scale. Each meal must be eaten in its entirety for the diet to be the most effective. The diet was originally used in the 1920’s, but fell to disuse for many years with the availability of new seizure medications.
How does the diet work?
The special combination of foods in the ketogenic diet causes the body to use mostly fat for energy. The body makes ketones as an end result.
What type of seizures is the ketogenic diet helpful for?
The diet works for different types of seizures and has not been limited to any one type.
How effective is the diet at controlling or eliminating seizures?
The diet has never been evaluated in a controlled scientific study. Studies that have followed children on the diet for long periods reveal that one-third of children treated with the ketogenic diet have greater than 90% seizure control with half of these children becoming seizure free. An additional one-third gain a 50% reduction in seizures. The remaining one-third discontinue the diet due to its ineffectiveness or its difficulty.
How is the diet initiated?
The diet is initiated under close medical supervision in the hospital. The diet is started gradually, and increased to the full amount over a three to four day period. During this time, blood sugar and ketone levels are monitored. A fasting period is not necessary to start the diet, although it is used at some medical centers. The child may go home when he or she is tolerating the full ketogenic diet.
How soon does it take for the diet to reduce or eliminate seizures?
The diet can become effective immediately or can take several months. Each child is unique and has different seizure patterns and frequency. There is usually improvement within the first ten weeks on the ketogenic diet.
Will anti-seizure medications be stopped after my child goes on the diet?
If the child is taking more than one anti-seizure medication, one medication may be reduced as the child starts the ketogenic diet. The reduction of remaining seizure medication may be made if the child’s seizures improve over time.
Is the diet healthy for my child?
The diet alone is inadequate in many vitamins and minerals. Supplements will be prescribed for your child while on the ketogenic diet therapy. The diet is used for two to three years. A regular diet is then resumed.
Are there any adverse effects of the ketogenic diet?
The most common adverse effect of the diet is constipation. There are several options available to prevent this problem including eating high fiber vegetables that are allowed on the diet and drinking enough water. A less common adverse effect is kidney stones. This problem can be prevented by making sure that the child drinks enough water. Other less common adverse effects include elevated lipids and decreased growth rate. Ask your ketogenic team about these effects.
For more information about the Ketogenic Diet Program at Penn State Milton S. Hershey Medical Center, call Pediatric Neurology at 717-531-8790.