My experience working on a pediatric and adult neurology unit has allowed me to take care of patients suffering from epilepsy. Many of these patients were admitted to the hospital to trial the ketogenic diet as an alternative treatment for their drug-resistant epilepsy. About one-third of epilepsy patients do not respond well to anti-epileptic drug treatment and recent research has shown that the ketogenic diet has decreased seizure frequency and improved cognitive function (Ułamek-Kozioł, Czuczwar, Januszewski, & Pluta, 2019). This diet is high in fats and low in carbohydrates, which allows the body to metabolize ketone bodies rather than glucose for energy. Ketone bodies are substances that are synthesized in the liver during times of fasting and starvation. It is suspected that decreased glucose consumption may affect the potassium channels on neurons, resulting in a hyperpolarization of the membrane. A hyperpolarization of neuron cells means that potassium ions (K+) are being pumped out of the cells. This prevents excessive neuronal firing and subsequently increases seizure threshold (Ułamek-Kozioł, et al., 2019). An increased seizure threshold means that it is less likely for a seizure to occur.
Further research must be conducted to evaluate the therapeutic efficacy of the ketogenic diet for epilepsy patients. This is because the mechanisms in which the ketogenic diet effects brain function are largely unknown and can have different targets within the body. With respect to anti-epileptic therapies both drug and diet changes, the ketogenic diet should be considered as a first-line treatment because it is less invasive and has shown various improvements in seizure frequency and cognitive function. When evaluating the four main biomedical ethical values, this topic considers patient autonomy and beneficence. Patients suffering from epilepsy should be provided with education regarding available treatments and the risks and benefits of each treatment. This allows patients to exercise their autonomy by choosing which treatment could potentially work best for them. Additionally, implementing the ketogenic diet as a therapy for epilepsy also involves beneficence. Medical professionals that provide patients with this treatment option are doing good by the patient because they are offering a less invasive and economically sustainable treatment option as opposed to drug therapy.
Ułamek-Kozioł, M., Czuczwar, S. J., Januszewski, S., & Pluta, R. (2019, October 18). Ketogenic Diet and Epilepsy. Retrieved September 08, 2020, from https://www.mdpi.com/2072-6643/11/10/2510/htm
This is very interesting, Katie! It's crazy how diet can play such a drastic role in every system of the body. I've personally tried the ketogenic diet and found it very difficult due to how strict it is. It almost seems that the likelihood of patient compliance with this treatment could be lower than taking daily medication. Might this factor into how likely doctors are to suggest it?
ReplyDeleteI also wondered if intermittent fasting would have the same effect as the ketogenic diet and found some interesting results. According to an article from 2013, fasting was historically used as treatment for seizures, even by Hippocrates. However, fasting does not prevent seizures by the same mechanism as the ketogenic diet and may be better used to support the effects of the diet rather than used on its own (Hartman, Rubenstein & Kossoff, 2013).
Hartman, A. L., Rubenstein, J. E., & Kossoff, E. H. (2013). Intermittent fasting: A “new” historical strategy for controlling seizures?. Epilepsy research, 104(3), 275-279.
Hi Katie. I really liked the ketogenic diet topic choice. I have tried the keto-diet and pretty much failed miserably because I felt like by body was constantly in a state of starvation. I also noticed that I lost a lot of strength in my resistance training, and I was always in a terrible mood. My personal experience with the ketogenic diet has exclusively been negative, so I was curious to see if there were any other negative outcomes of the keto-diet in the literature. Interestingly enough, in my research, I found an article that explained the use of the ketogenic diet to treat epilepsy in children 4-5 years of age. Out of 158 child subjects, adverse effects attributed to the keto-diet occurred in 126 children (80%). These adverse effects included emesis, food refusal, and hypoglycemia (Lin, Turner, Doerrer, et al., 2017). I noticed you said you also worked in the pediatric neurology unit. Did healthcare provider implement the keto-diet in kids to try and treat their epilepsy? And if not, what was the alternative treatment for pediatric epilepsy?
ReplyDeleteLin, A., Turner, Z., Doerrer, S. C., Stanfield, A., & Kossoff, E. H. (2017). Complications During Ketogenic Diet Initiation: Prevalence, Treatment, and Influence on Seizure Outcomes. Pediatric neurology, 68, 35–39. https://doi.org/10.1016/j.pediatrneurol.2017.01.007
Hello Katie,
ReplyDeleteThank you for sharing this post and I found it very interesting. I did not know that the ketogenic was so effective in treating epilepsy. I am doing my thesis project on treatments for women who are or plan to become pregnant with epilepsy. Interestingly, I did not come across any research using the ketogenic diet as a treatment for pregnant women with epilepsy. The dangers of having a seizure while pregnant are critical and cause great harm to both the mother and the fetus. Because of this, nearly all of the literature talks about how important it is to have seizures managed with medication prior to pregnancy (Tomson et. al., 2019).
Seizure prevalence increases in pregnant women and some medications must also be increased since some medications are metabolized and cleared faster during pregnancy (Tomson et. al., 2019). I think it would be interesting to do a research project comparing epileptic pregnant women who are just on anti-epileptic drugs with epileptic pregnant women on anti-epileptic drugs and following the ketogenic diet. Do you think there would be specific ethical concerns with conducting a research study like this?
Tomson, T., Battino, D., Bromley, R., Kochen, S., Meador, K., Pennell, P., & Thomas, S. V.
(2019). Executive Summary: Management of epilepsy in pregnancy: A report from the
International League Against Epilepsy Task Force on Women and Pregnancy. Epilepsia,
60 (12), 2343-2345. doi:10.1111/epi.16395