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The Ketogenic Effect

Pediatric Neuro News
March 31, 2013

California couple find a palatable answer in Baltimore for their daughter’s persistent seizures.

Eric Kossoff

Eric Kossoff, M.D. 

Emergency medicine physician Tom Minahan was working the night shift at a Los Angeles hospital when his wife called with concerns that their then 14-month-old daughter, Mallory, might have suffered a seizure. “Bring her into the ED and we’ll get her checked out,” Minahan said. When she did, the EEG showed no signs of seizure. The Minahans were relieved until a month later, when Mallory suddenly stared off to the left side for a minute. Similar seizures would follow.

“Our thinking was she was having some seizures and with medications she would grow out of it,” says Minahan.

So, following tests and an evaluation by a pediatric neurologist, Mallory was put on one medication, then another and another, a therapeutic routine that the Minahans would re-live repeatedly over the next eight years as the seizures—along with the distressing side effects of the drugs—continued. When one anticonvulsant drug didn’t work, doctors would prescribe another.

“I’m thinking, what are we doing here?” says Minahan. “What’s worse? The seizures or the side effects?”

The Minahans also learned there was no surgical intervention for Mallory’s type of generalized seizures, nor any other options, for that matter. But in searching the literature, Minahan read about the Johns Hopkins Children’s Center’s success with the high-fat, low-carbohydrate ketogenic diet as seizure therapy, including a study that showed one-third of ketogenic diet patients were either seizure-free or had a greater than 90 percent reduction in seizures (Pediatrics, October 2001;108(4)). Hopkins had also created a less-restrictive alternative to the ketogenic diet—the modified-Atkins diet—which the Minahans tried after consulting with an L.A. specialist. Mallory struggled with the diet, however, prompting a call to Hopkins pediatric neurologist Eric Kossoff and a flight across the country to meet with him.

Kossoff recommended the ketogenic diet, assuring the Minahans of the diet’s efficacy in reducing the frequency and severity of seizures. Its mechanism is unknown, Kossoff explained, but theoretically the diet’s suppression of seizures may be partially related to the buildup and breakdown of ketones, a chemical byproduct of fat. Kossoff added that the diet’s therapeutic effects are often longer lasting than those of medications, and come with fewer side effects. However, the diet does require rigorous monitoring.

The Minahans started the ketogenic diet in July 2012. Within six weeks, Kossoff notes, the nature of Mallory’s seizures began to decrease in overall number with some seizures clustering, but less severely.

“Most kids who improve on the ketogenic diet have decreases in their seizures within two or three months, so she’s fitting into that category,” says Kossoff. “She’s still having seizures, but they’re reduced somewhat in frequency and intensity. Hopefully she’ll continue to get better and her seizures will become more sporadic and less intense.”

Adds Minahan, “We may get seizure freedom, that’s a possibility. So, we may have a phenomenal story to tell in a couple of years.”

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