16. The Ketogenic Diet

This is a difficult diet to maintain, but it does prevent seizures, especially in younger children (1-8 years). Seizures that fail to be controlled with anti-convulsant medications may respond well to this diet.

The diet's mechanism is based on the principle that starvation may prevent seizures. During a starvation period, fat is broken down for energy metabolism. When fat is broken, ketone bodies are formed. These are acetone, acetoacetic acid, and beta-aminobutric acid. The ketone bodies have anti-seizure properties. By applying the Ketogenic diet, one stimulates a starvation situation without actively starving. This is accomplished by feeding an individual only fat. When fat is consumed it is broken into the ketone bodies as if these are the actual fat stores of the body. During the period of treatment (usually 2 years), a child cannot have any carbohydrate intake (bread, pasta, sugar, or flour products). Proteins are limited to a small amount and the entire diet is strictly calculated to the gram. Also the fluid intake is limited in order to maintain a proper concentration of ketones.

The general notion is that the diet stops seizures in 30%, reduces them in 30%, and is ineffective in about 30%. The best candidates are children who have frequent small generalized or focal seizures who didn't respond to any anticonvulsant or can't tolerate them due to side effects and are between 1 and 8 years of age. Some severe seizure forms such as Lenox-Gastaut syndrome or infantile spasms may respond well to the diet.

The diet is not free of side effects, other than the inconvenience of maintaining it. The diet may cause growth retardation, kidney stones, side effects related to exposure to fat, and more. Proper vitamin supplementation, calcium, and mineral supplementation must be maintained while on the diet. Still, with all its difficulties, for the right candidate with a motivated capable family, this is an excellent option to be considered.