Epilepsy is a chronic neurologic condition causing recurrent seizures, mostly seen in children younger than 2 years and adults older than 65 years of age. Nutritional therapy is being used in addition to other epileptic treatments, such as anticonvulsant medications, epilepsy surgery, and vagus nerve stimulation, but considering their complications. For example Carbamazepine (Tegretol) a widely-used anticonvulsant medication to treat focal seizures, have shown to increase the metabolism of vitamin D, calcium, folate, and biotin. Hence, patients on Carbamazepine medication should ensure adequate intake of foods rich in these nutrients, including green leafy vegetables for folate and biotin and fortified dairy products or its substitutes for calcium and vitamin D. Also dietary supplementation especially for calcium and vitamin D may be necessary for those who are on long-term medication of carbamazepine.
There are evidences that a ketogenic diet (with high fat, low carbohydrate and adequate protein) have shown to decrease the frequency of seizures; however, further research is necessary. Studies have shown that following a caloric restrictive diet enrich in polyunsaturated fatty acid (with omega 3 and 6) can be an ideal approach while treating epileptic patients. Further Atkins diet, which is high in fat and protein while low in carbohydrate, has also been used in treatment of epilepsy.
Ketogenic Diet (KD)
By now, the KD is well known to the epilepsy community. It was initially devised in 1921 to mimic the anticonvulsant effects of fasting, which were known to suppress seizures. (1) The success rate of the KD in controlling refractory seizures is at least as good as, and often better than that of the “new” anticonvulsant drugs (AEDs). (2) The KD is effective in people of all ages, although it may be maximally effective in the toddler and school-age child (3,4,5).
Typically, a KD includes mostly saturated fats, usually in the form of heavy cream or butter. Fats in the classic KD consist of a mixture of animal- and plant-derived fats; fatty acids of various chain lengths are likely to be included, but no attempt is made to specify fat type or chain length in the diet formulation. An exception is the medium-chain triglyceride (MCT) diet, in which oils containing certain chain lengths are the main source of fat (6).
Atkins Diet
Atkins Diet has been widely used for weight loss benefits. Because Atkins diet consist of high fat and low in carbohydrate it is known to produce a state of ketosis, similar to that of Ketogenic Diet, hence theoretically it is possible that the Atkins diet may enable seizure control. A small case series appeared recently, attesting to the effectiveness of the Atkins diet on seizure control in six patients (three children, one adolescent, and two adults), ranging in age from 7 to 52 years, with diverse types of refractory epilepsy (7). With regard to seizure control, the results were remarkable: two children and the teenager had a greater than 90% seizure reduction. Although this is a small, uncontrolled trial, it raises the possibility that the Atkins diet may be beneficial for children with medically refractory epilepsy. The Atkins diet seems to work better in children, as does the KD. The Atkins diet was less encouraging in adults with epilepsy, but larger-scale studies are necessary.
Calorie Restrictive Diet
The original idea for a KD was derived from the beneficial effect that fasting had on seizures, and this observation has been verified in the modern setting (8). The health benefits of modest calorie restriction are becoming increasingly clear and include an increased life span, reduced risk of cancer and cardiovascular disease, and amelioration of the degenerative effects of aging (9,10). Restriction of calorie intake also can be neuroprotective (11,12).
Polyunsaturated Fatty Acids (PUFA)
Fatty acids play a critical role in nervous system development. The essential fatty acids, especially the long-chain polyunsaturated fatty acids (PUFAs) of the ω-3 class (as found in certain fish oils), are necessary for the development of normal retinal and neuronal membranes, as well as for subsequent normal behavior and cognition (13,14). Deficiencies of PUFAs lead to cognitive, behavioral, and structural brain abnormalities. Consumption of omega-3 PUFAs may even counteract the degenerative effects of Alzheimer disease (15). Although clinical dietary trials demonstrating that PUFAs effectively reduce disorders of cardiac excitability were promising (16), few analogous attempts have been made to test PUFAs for seizures, in either patients or animal models. A single study has attempted a clinical trial of a PUFA-enriched diet in patients with epilepsy (17). Hence, the studies have shown that PUFAs play a primary role in brain development and in the modulation of neuronal excitability. However, exploration of their function in treatment of epilepsy is still at beginning stage. It is possible that a “PUFA diet,” parallel with the ketogenic diet, may become a possible mode of nutritional therapy for epilepsy in near future.
References:
- Wilder RM. The effects of ketonemia on the course of epilepsy. Mayo Clin Proc. 1921;2:307–308.
- Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Lefevre F, Aronson N , Pediatrics. 2000 Apr; 105(4):E46.
- A multicenter study of the efficacy of the ketogenic diet., Vining EP, Freeman JM, Ballaban-Gil K, Camfield CS, Camfield PR, Holmes GL, Shinnar S, Shuman R, Trevathan E, Wheless JW, Arch Neurol. 1998 Nov; 55(11):1433-7.
- The ketogenic diet for intractable epilepsy in adults: preliminary results. Sirven J, Whedon B, Caplan D, Liporace J, Glosser D, O'Dwyer J, Sperling MR, Epilepsia. 1999 Dec; 40(12):1721-6.
- Experience with the ketogenic diet in infants., Nordli DR Jr, Kuroda MM, Carroll J, Koenigsberger DY, Hirsch LJ, Bruner HJ, Seidel WT, De Vivo DC, Pediatrics. 2001 Jul; 108(1):129-33.
- Medium-chain triglycerides as a therapy for intractable childhood epilepsy. Huttenlocher PR, Wilbourn AJ, Signore JM, Neurology. 1971 Nov; 21(11):1097-103.
- Efficacy of the Atkins diet as therapy for intractable epilepsy. Kossoff EH, Krauss GL, McGrogan JR, Freeman JM, Neurology. 2003 Dec 23; 61(12):1789-91.
- Seizures decrease rapidly after fasting: preliminary studies of the ketogenic diet. Freeman JM, Vining EP, Arch Pediatr Adolesc Med. 1999 Sep; 153(9):946-9.
- Restriction of energy intake, energy expenditure, and aging. Ramsey JJ, Harper ME, Weindruch R, Free Radic Biol Med. 2000 Nov 15; 29(10):946-68.
- How does calorie restriction work? Koubova J, Guarente L, Genes Dev. 2003 Feb 1; 17(3):313-21.
- Molecular mechanisms of brain aging and neurodegenerative disorders: lessons from dietary restriction., Prolla TA, Mattson MP
Trends Neurosci. 2001 Nov; 24(11 Suppl):S21-31.
- Dietary restriction differentially protects from neurodegeneration in animal models of excitotoxicity. Contestabile A, Ciani E, Contestabile A, Brain Res. 2004 Mar 26; 1002(1-2):162-6.
- Lipids and neurodevelopement.Uauy R, Mena P, Nutr Rev. 2001 Aug; 59(8 Pt 2):S34-46; discussion S46-8.
- Plausible explanations for effects of long chain polyunsaturated fatty acids (LCPUFA) on neonates. Kurlak LO, Stephenson TJ Arch Dis Child Fetal Neonatal Ed. 1999 Mar; 80(2):F148-54.
- Consumption of fish and n-3 fatty acids and risk of incident Alzheimer disease. Morris MC, Evans DA, Bienias JL, Tangney CC, Bennett DA, Wilson RS, Aggarwal N, Schneider J Arch Neurol. 2003 Jul; 60(7):940-6.
- The antiarrhythmic and anticonvulsant effects of dietary N-3 fatty acids. Leaf A, Kang JX, Xiao YF, Billman GE, Voskuyl RA J Membr Biol. 1999 Nov 1; 172(1):1-11.
- Diet enriched with omega-3 fatty acids alleviates convulsion symptoms in epilepsy patients. Schlanger S, Shinitzky M, Yam D
Epilepsia. 2002 Jan; 43(1):103-4.
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Nutan Khimasiya certified Fitness and Nutrition expert. Nutan Khimasiya is internationally certified Fitness and Nutrition expert from ACSM-Clinical Nutrition, K11-Sports Nutrit..
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