Using diet for medicinal purposes has been known since the beginnings of medicine. Due to the lack of other methods, diet was also used in epilepsy treatment. The ketogenic diet has been used for over 80 years and it is quite effective. Even though pharmacological treatment of epilepsy is widely available nowadays, not every child with epilepsy responds well enough to it. This is the reason for the growing interest in ketogenic diet (KD).
Starvation diet as a treatment has been known for centuries. It was used by Chinese, Tibetan, Persian, Babylonian, Arab, Jewish, Greek and Romanian medics. Even Hippocrates, the father of medicine, recommended fast to his patients until they see the first symptoms of health. Galen, a Roman doctor, said that restraining oneself from eating from time to time helps to cleanse the whole body. The Arab scholar, Avicenna, who was an author of the treatise which was the foundation of European medicine for many centuries, claimed that starvation diet is one of the most important therapeutic methods. This diet was also used in epilepsy treatment as there were no any other ways to treat it. Rafael Santi on his unfinished painting titled “Transfiguration” depicts the biblical scenes described in The Gospel According to Mark, when Jesus says: “It can be thrown away only by means of prayer and starvation” and he must have been talking about epilepsy. In the nineteenth century when pharmacological treatment was based on using phenobarbitals or bromides, and surgical treatment was very rare, the idea of treating epilepsy by means of diet was very popular among scientists and doctors [1].
Nowadays, a few kinds of ketogenic diet are known. The so-called “classic” ketogenic diet is the most popular. It is based on long-chain fatty acids. In the 1950s a new kind of diet was invented. It was based on medium-chain fatty acids and it produced a bigger ketosis. However, it is rarely used as it causes intestinal disorders and it is not well tolerated by patients. Ketosis became less popular in epilepsy treatment in the 1930s. Instead, the doctors started using some new forms of phenytoin therapy. These new methods became more easier to apply than a diet. Treating epilepsy by means of pharmaceuticals became the main subject of research and the only form of therapy until the 1990s. Despite the obvious success of ketogenic diet, it was rarely used. The lack of experienced doctors and nutritionists levelled its therapeutical effects significantly. It was believed that it is too rigorous, tasteless and that it complicates patients’ everyday life [1,4].
Currently, despite the huge success of pharmacotherapy of epilepsy, ketogenic diet is one of the most effective ways to treat epilepsy. The interest in the diet increased due to the possibility of treatment of drug-resistant epilepsy and the forms of epilepsy which occur in children such as West, Lennox-Gastaut and Dravet syndromes. Despite clinical data about the effectiveness of the ketogenic diet, its mechanism is not fully known. Simon Eaton, a biochemist from the Institute of Child Health, presented a number of ideas connected with the “classic” ketogenic diet. According to his ideas, the state of ketosis is responsible for equalization of amino acid disorders, changes in the nerve cells (which can reduce neural excitability and therefore work against epilepsy), regulation of the genes, and the acidification in central nervous system. In 1998 the biggest research on the ketogenic diet confirmed its effectiveness. Freeman, an author of the research, analyzed the impact of ketogenic diet on the reduction of epileptic seizures in 150 children (from 4 months-old to 16 years-old). Before the treatment the children had approximately 410 seizures a month. After 6-12 months of the diet about half of them had only 50% of the previous number of fits. In some cases, ketogenic diet contributed also to the reduction of doses or to complete resignation from the antiepileptic drugs. Nowadays, despite the huge progress in pharmacotherapy of epilepsy, the ketogenic diet is still a way of treating it [1,5].
Written by: Anna Brończyk-Puzoń
Source:
1. Chorągwiewicz T., Żarnowska I., Gąsior M. i wsp. Anticonvulsant and neuroprotective effects of the ketogenic diet. Przegląd Lekarski 2010; 67, 3, 205-2012.
2. Conklin H.W. Cause and treatment of epilepsy. Jam. Osteopatic. Assoc. 1922; 26, 11.
3. Wilder R.M. The effect of ketonemia on course of epilepsy. Mayo Clin. Proc. 1921; 2, 307.
4. Huttenlocher P.R. Wilbourn A.J. Signore J.M. Medium-chain triglicerides as a therapy for intractable childhood epilepsy. Neurology 1971; 21, 1097
5. Starbała A. Bawa H. S. The Role of the ketogenic diet in the management of epilepsy. ROCZN. PZH 2007; 58, 1-6, 139-143.
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