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Dr. Peter Brukner OAM5 min read

Show me the evidence: Low carb and childhood epilepsy

The ketogenic diet (KD) has been used to treat epilepsy in children since 1921. The original protocol using a high fat, low carbohydrate diet was created at the Mayo Clinic in Rochester, USA (Wilder, 1921), and popularized by the Johns Hopkins Hospital in Baltimore, MD (Freeman et al.,1998). It is now used in the management of drug-resistant childhood epilepsy in all the leading childrens’ hospitals throughout the world.

Wilder RM. (1921) The effect of ketonemia on the course of epilepsy. Mayo Clin Bulletin 2:307–308.

Freeman JM, Vining EPG, Pillas DJ, Pyzik PL, Casey JC, Kelly MT. (1998) The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics 102:1358–1363.

In December 2006, The Charlie Foundation commissioned a panel comprised of 26 pediatric epileptologists and dietitians from nine countries with particular expertise using the KD. This group was created in order to create a consensus statement regarding the clinical management of the KD. Subsequently endorsed by the Practice Committee of the Child Neurology Society, this resultant manuscript addresses issues such as patient selection, pre-KD counseling and evaluation, specific dietary therapy selection, implementation, supplementation, follow-up management, adverse event monitoring, and eventual KD discontinuation

*Kossoff EH, Zupec-Kania BA, Amark PE, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Charlie Foundation, Practice Committee of the Child Neurology Society; Practice Committee of the Child Neurology Society; International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304-17. doi: 10.1111/j.1528-1167

This was subsequently updated in 2018.

Kossoff EH, Zupec-Kania BA, Auvin S, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic DietStudy Group. Charlie Foundation; Matthew's Friends; Practice Committee of the Child Neurology Society. Epilepsia Open. 2018 May 21;3(2):175-192. doi: 10.1002/epi4.12225

Goswami and Sharma wrote in 2019 “Ketogenic diet (KD) is a time-tested therapeutic modality for refractory epilepsy, which has re-emerged as a robust alternative to anti-epileptic pharmacotherapy. There is a growing body of evidence which supports the anti-seizure efficacy, safety profile and feasibility of KD use in childhood epilepsy.”

Goswami JN, Sharma S. Current perspectives on the role of the ketogenic diet in epilepsy management. Neuropsychiatric Disease and Treatment 2019:15 3273–3285

Two meta-analyses were published in 2020. Soubron et al concluded that “Despite the heterogeneity between all studies, the beneficial results underline that dietary interventions should be considered for children and adolescents with refractory epilepsy who are not eligible for epilepsy surgery.” Lyons et al concluded that “Ketogenic diet therapy is an effective treatment option for infants with drug-resistant epilepsy.”

*Sourbron, J., Klinkenberg, S., van Kuijk, S.M.J. et al. Ketogenic diet for the treatment of pediatric epilepsy: review and meta-analysis. Childs Nerv Syst 36, 1099–1109 (2020). https://doi.org/10.1007/s00381-020-04578-7

Lyons L, Schoeler NE, Langan Lyons L, Schoeler NE, Langan D, Cross JH. Use of ketogenic diet therapy in infants with epilepsy: A systematic review and meta-analysis. Epilepsia. 2020;61:1261–1281*

FURTHER REFERENCES

  1. Liu XY, Chen J, Zhu M, et al. Three and Six Months of Ketogenic Diet for Intractable Childhood Epilepsy: A Systematic Review and Meta-Analysis. Front Neurol. 2019;10:244. doi:10.3389/fneur.2019.00244
  2. Cai Q-Y, Zhou Z-J, Luo R, et al. Safety and tolerability of the ketogenic diet used for the treatment of refractory childhood epilepsy: a systematic review of published prospective studies. World J Pediatr. 2017;13(6):528-536. doi:10.1007/s12519-017-0053-2
  3. Kim SH, Shaw A, Blackford R, et al. The ketogenic diet in children 3 years of age or younger: A 10-year single-center experience. Scientific Reports. 2019;9(1):8736. doi:10.1038/s41598-019-45147-6
  4. Luz IR, Pereira C, Garcia P, et al. Ketogenic Diet for Refractory Childhood Epilepsy: Beyond Seizures Control, the Experience of a Portuguese Pediatric Centre. Acta Médica Portuguesa. 2019;32(12):760-766. doi:10.20344/amp.12184 PDF
  5. Le Pichon JB, Thompson L, Gustafson M, Abdelmoity A. Initiating the ketogenic diet in infants with treatment refractory epilepsy while maintaining a breast milk diet. Seizure. 2019;69:41-43. doi:10.1016/j.seizure.2019.03.017
  6. Dressler A, Trimmel-Schwahofer P. The ketogenic diet for infants: How long can you go? Epilepsy Res. 2020;164:106339. doi:10.1016/j.eplepsyres.2020.106339 ABSTRACT
  7. Wirrell E, Eckert S, Wong-Kisiel L, Payne E, Nickels K. Ketogenic Diet Therapy in Infants: Efficacy and Tolerability. Pediatr Neurol. 2018;82:13-18. doi:10.1016/j.pediatrneurol.2017.10.018
  8. Sharma S, Goel S, Kapoor D, et al. Evaluation of the Modified Atkins Diet for the Treatment of Epileptic Spasms Refractory to Hormonal Therapy: A Randomized Controlled Trial. J Child Neurol. Published online April 9, 2021:8830738211004747. doi:10.1177/08830738211004747
  9. Zhang J, Chen G, Wang J, et al. Efficacy of the ketogenic diet on ACTH- or corticosteroid-resistant infantile spasm: a multicentre prospective control study. Epileptic Disord. Published online March 26, 2021. doi:10.1684/epd.2021.1256
  10. Lin K-L, Lin J-J, Wang H-S. Application of ketogenic diets for pediatric neurocritical care. Biomedical Journal. Published online July 5, 2020. doi:10.1016/j.bj.2020.02.002
  11. Singh RK, Joshi SM, Potter DM, Leber SM, Carlson MD, Shellhaas RA. Cognitive outcomes in febrile infection-related epilepsy syndrome treated with the ketogenic diet. Pediatrics. 2014;134(5):e1431-1435. doi:10.1542/peds.2013-3106
  12. García-Peñas JJ. S.L.U 2021 Viguera Editores. Epilepsy, cognition, and the ketogenic diet: Neurología.com. doi:10.33588/rn.66S01.2017529

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