One possible treatment for epilepsy in children is the ketogenic diet, a high-fat, low-carbohydrate regimen. This forces the body to break down fats for energy, rather than burning carbohydrates.

Previous studies have found that the diet isn't effective to reduce seizure frequency in adults. The diet requires a large consumption of fatty foods, like oils, cream, butter, and mayonnaise, which many people find unappealing. The diet is very restrictive: calorie intake and fluid intake must be accurately calculated, and these limits must be followed. Starting the diet usually requires a short period with no food intake at all, usually in hospital. The diet is therefore so intense it counts as a medical treatment and must be prescribed. It's thought that adults find the diet much more difficult to follow than children (imagine going to a restaurant with friends - what could you eat?), and that this explains the low success rate.

A more appealing version of the diet?
Researchers in Baltimore, USA, have been looking into using a modified version of the Atkins diet to treat epilepsy. The Atkins diet is like the ketogenic diet in that it drastically restricts the amount of carbohydrate eaten, but unlike the ketogenic diet, total protein, calorie and fluid intake are not restricted, making it much more flexible. It also doesn't require a fast to begin. A study has already found that a diet of this type effectively treats epilepsy in children.

In last month's edition of the journal Epilepsia, Professor Eric Kossoff and colleagues at Johns Hopkins University published the results of their trial of the modified Atkins diet in thirty adults with drug-resistant epilepsy, having on average ten seizures a week. Participants had to keep a diary noting what they ate and how many seizures they had.

Nearly half of the people in the trial experienced a significant drop in seizure frequency (fewer than half as many seizures) after three months on the diet, though this fell to a third of patients after six months. If the diet worked, its effects were usually apparent within two weeks. Most patients lost weight during the trial. On average, the more a patient lost weight on the diet, the greater their reduction in seizure frequency. However one third of people in the study stopped the diet before reaching the three month point because they found it too restrictive.

Professor Kossoff concluded that though the diet didn't work for everyone, it was effective for some adults with epilepsy, offering a new treatment option for this age group.

So how does the diet actually work?
Breaking down fats for energy rather than carbohydrates alters the body's chemistry in two ways. Firstly it increases the amounts of chemicals called ketones in the body, as these are by-products of metabolising fats. (These are normally present in the body, but in much smaller amounts.) At the same time, the normal process of breaking down carbohydrates for energy (which is called glycolysis) is sidelined, and its by-products are present in smaller amounts. The combination of these effects alters the way cells work in a number of ways, which protects against seizures. Ketones may also interact with potassium channels in neurones, reducing their firing. Artificially blocking carbohydrate breakdown (and thus removing its by-products) with a drug has also been shown to delay the development of
seizures in rats.

A review of recent research by on this topic was published in
February 2008 in the journal Current Opinion in Clinical Nutrition and Metabolic Care.

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More information about the ketogenic diet can be found here
and here