Dietary treatment of Epilepsy
• Hippocrates first to mention use of starvation as a treatment of epilepsy
• First investigated in 1921
• Consists of:
o High fat, low carbohydrate diet
o Typically 3:1 or 4:1 ratio of fat (grams) to protein plus carbohydrate (grams)
o (Carb:protein:fat 4% 6% 90%)
• Suitable for broad spectrum of epilepsy
o IGE - Absence epilepsy in children ~30% seizure free
• First line treatment for:
o GLUT-1 deficiency
o Pyruvate dehydrogenase deficiency
• Early consideration in:
o Dravet Syndrome
o LGS
o Doose syndrome
o Infantile epileptic spasms
• Highly variable according to study and syndrome etc. rough figures below:
• Children
o 50-60% have >50% seizure reduction
o 33% have >90% response
• Adults
o 49% have >50% seizure reduction
o 13% seizure free
• Other benefits
o Weight loss
o Improvement in DM type 2
• GI upset
• Weight Loss
• Increase in lipids
o Usually transient over ~12 months
• Vitamin and mineral deficiency
o Selenium
• Osteopaenia
• Renal stones 3-7%
• Pancreatitis (rare)
• Very variable compliance based depending on study, age group and ethnic origin
• Overall ~50% do not tolerate in short term
• High fat, low carbohydrate diet (Carb:protein:fat 5% 30% 65%) 4, 6, 9
• Typically a 10-20g/day limit on carbohydrate
• No need to admit for initial titration
• No restriction on calories, protein or fluid intake
• Children
o 48% had >50% seizure reduction
o 13% seizure free
• Slightly better than ketogenic diet
• 42% do not tolerate in short term
Medium chain triglyceride diet (MCT) (Carb:protein:fat 17% 10% 73%)
Low glycaemic (diabetic)LGIT (Carb:protein:fat 10% 30% 60%)
• Dietary therapy debate Epilepsia 56(9) 1325 (2015)