Neurology Quiz: 5 Things to Know About Diet and Epilepsy

The four main types of ketogenic diets include:
1. classic ketogenic diet
2. medium chain triglyceride diet
3. modified Atkins diet
4. low glycemic index diet

The classic ketogenic diet is a high fat diet, with about 90% of daily calories from fat. In the medium chain triglyceride (MCT) diet, 60% of daily energy comes from medium chain triglycerides. The modified Atkins diet (MAD) is a high-fat, low-carbohydrate diet similar to the classic ketogenic diet, but without a set ketogenic ratio. The low glycemic index treatment (LGIT) diet provides more liberal total daily carbohydrate intake and favors foods with low glycemic indices. The Ornish diet is an extremely low-fat diet, with about 10% of calories per day from fat.

Source: Kossoff EH, Zupec-Kania BA, Auvin S, et al, for the Practice Committee of the Child Neurology Society. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;3:175-192.

 

According to 2018 guidelines from the International Ketogenic Diet Study Group, ketogenic diets should be considered in children after two failed trials of antiepileptic drugs. Earlier initiation can be considered in children with certain epilepsy syndromes, such as Angelman Syndrome, infantile spasms, or FIRES.

Source: Kossoff EH, Zupec-Kania BA, Auvin S, et al, for the Practice Committee of the Child Neurology Society. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group.Epilepsia Open. 2018;3:175-192.

 

According to 2016 European guidelines on the ketogenic diet in infants with refractory epilepsy, the following are absolute contraindications for the ketogenic diet in infants: fatty acid oxidation deficiencies, pyruvate carboxylase deficiency and other gluconeogenisis defects (e.g. fructose 1,6 diphosphatase deficiency), glycogen storage diseases (except type 2), ketolysis defects, ketogenesis defects, porphyria, prolonged QT syndrome (and other cardiac diseases), liver, kidney or pancreatic insufficiency, and hyperinsulinemia.

Source: van der Louw E, van den Hurk D, Neal E, et al. Ketogenic diet guidelines for infants with refractory epilepsy. Eur J Paediatr Neurol. 2016;206:798-809.

 

According to 2018 guidelines from the International Ketogenic Diet Study Group, ketogenic diets are the treatment of choice in glucose transporter 1 deficiency syndrome (Glut1DS) and pyruvate dehydrogenase deficiency (PDHD). Alport syndrome, or hereditary nephritis, is a genetic disorder characterized by glomerulonephritis, declining renal function, end stage renal disease, and hearing loss. Affected individuals may need to follow a diet that limits excess sodium, protein and phosphorus.

Source: Kossoff EH, Zupec-Kania BA, Auvin S, et al, for the Practice Committee of the Child Neurology Society. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group.Epilepsia Open. 2018;3:175-192.

 

Constipation is the most frequently reported adverse effect of ketogenic diets. Hyperlipidemia is also commonly reported and may normalize over the first year of treatment. Other commonly reported adverse effects include weight loss, growth problems in children, nausea and vomiting, behavior problems and irritability, lethargy, hypercalciuria, increased liver enzymes, renal stones, diarrhea, and hypoglycemia. There have only been a few reports of loss of bone mineral density in children who followed the ketogenic diet, and reports in adults suggest no loss of bone mineral density over long-term follow-up.

Source: Schoeler NE, Cross JH. Ketogenic dietary therapies in adults with epilepsy: a practical guide. Pract Neurol. 2016;16:208-14.