COMMENTARY

The Ketogenic Diet for Adults With Epilepsy

Andrew N. Wilner, MD

Disclosures

August 15, 2014

Discussion

This was a small, open-label, retrospective study of adults with difficult-to-treat seizures with a wide range of etiologies. It was surprising that none of the patients stopped the diet as a result of adverse events, because it has been my experience that many adult patients with epilepsy do not tolerate or exhibit sufficient dietary discipline to sustain restrictive diet therapy.

It is likely that these patients or their caregivers were highly motivated, because many previous therapies had failed. One patient was tube-fed and 2 were partially tube-fed, a nutrition route that enhances diet compliance. Furthermore, the close supervision these patients received by the medical team by email, text, and telephone probably contributed to their high adherence.

The study's small number of patients with highly diverse causes of epilepsy did not reveal a specific patient profile that predicted a favorable response. More research is needed on the basic mechanisms of diet therapy for epilepsy to help predict responders and those susceptible to adverse effects.

For patients with epilepsy refractory to AEDs, effective alternative treatments are needed. Neurostimulation therapies, such as VNS, DBS and RNS, are proven modalities for seizure control, but they are expensive, not available worldwide, and rarely produce freedom from seizures. Epilepsy surgery may be curative, but many patients with refractory epilepsy are not good surgical candidates.

This report by Schoeler and colleagues[2] suggests that the ketogenic and modified Atkins diets should be considered for adults with refractory seizures, both for seizure reduction as well as concomitant beneficial effects, such as increased alertness and concentration. A larger, prospective study would shed more light on the likelihood of success of diet therapy in a wider population of adults with refractory epilepsy.

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