Ketogenic diet: place in therapy Anti-epileptic medications provide approximately 60-75% of patient’s with seizure control If patient fails 3 medication trials, only 1-15% will achieve seizure control with additional medication combinations Surgery: 50-90% of appropriate epileptogenic zone resection candidates attain seizure control, but only 5-15% total qualify Minnesota Epilepsy Group, P.A.
Metabolism review: Typical diet: glucose pyruvate acetyl CoA Ketogenic diet: fatty acid acetyl CoA
Mitochondria uses ‘citric acid cycle’ to make ATP. Acetyl CoA is common substrate of both fatty acid & glucose metabolism. Minnesota Epilepsy Group, P.A.
Ketogenic diet ‘transition of energy production from carbohydrates to fats’ Effectiveness depends on the degree of carbohydrate restriction & maintenance of ketone level (BHB goal 3-4) Fat: carbohydrate + protein ratio of 3:1 - 4:1 3:1 diet has long-chain saturated fat (87% calories), carbohydrate (6%), protein (7%) Minnesota Epilepsy Group, P.A.
Ketogenic diet Mechanism of action: metabolism v anti- epileptic properties of ketones/fatty acid metabolites – Ex. Neurosteroids on GABA-a receptors Ref: Benaroch EE. Neurology 2007;68(8):612-614.
In 1923, Conklin treated epilepsy by prescribing “rest of gastrointestinal system” for 25 days. He reported 90% ‘success’ rate in children and 50% in adults. In 1921, Wilder introduced the ketogenic diet. Later reported 95% of patients showing improvement through treatment. Minnesota Epilepsy Group, P.A.
Ketogenic diet Why: role ketogenic diet in epilepsy therapy – Roughly 1 in 4 patients need new strategy beyond medications & surgery What: ketogenic diet mechanism – Shift in energy metabolism with direct or indirect anti-epileptogenic properties Who: syndrome & seizure types – Select patients & others who fail medication trials or who are not surgical candidates Where does it get you: results – 15% seizure freedom, 30% excellent results, 30% modest improvement How: strategy for tolerance & goals – Patience, consistency & teamwork Minnesota Epilepsy Group, P.A.
Thank You Jason Doescher, MD Pediatric Neurology & Epilepsy Minnesota Epilepsy Group, PA Saint Paul, Minnesota 651.241.5290 Minnesota Epilepsy Group