A ketogenic diet that is high in fat and low in carbohydrate has been used to treat seizures in children with epilepsy for nearly 90 years.

In June 2008, the journal Lancet Neurology published the results of the first randomised controlled trial of the ketogenic diet, which clearly demonstrated its efficacy in children aged between 2 and 16 years, who had failed to respond to two anti-epileptic drugs (AEDs).
See our July 2008 e-newsletter for more information.

Infantile spasms (IS) are a severe form of epilepsy that typically affects children aged between 4 and 8 months. Medications such as virgabatrin (not available in the USA) and andrenocorticotrophic hormone (ACTH) are commonly used to treat this condition, but can have damaging side-effects, such as visual deficits, brain defects and stomach ulcers.

In order to avoid these side-effects, researchers at the John Hopkins Centre in Baltimore, USA, have recently completed a retrospective analysis in which they prescribed a ketogenic diet for babies with IS, before trying medication. This is something that had never been trialled before.

The study involved 13 babies, all of whom were started on a ketogenic diet at the same time. If the diet successfully stopped the spasms, the babies were kept on it for 6 months. The electrical activity of the infants' brains was regularly monitored using electroencephalogram (EEG).

The diet worked in 8 out of 13 babies, within approximately one week. Only one of the 8 experienced recurring spasms, but these were rapidly controlled when the anti-epileptic drug (AED) topiramate was added to the diet. The 8 babies experienced fewer side-effects than typical ACTH-treated children, and they also had a lower rate of spasm recurrence.

The 5 babies who did not respond to the diet were instantly prescribed ACTH, and this worked rapidly in 4 cases.

The babies who were prescribed ACTH achieved a normal EEG pattern more quickly than the babies on the ketogenic diet, but longer-term follow-up showed that development in both groups was equal.

These results are very encouraging, because they show that the ketogenic diet is a viable first-choice treatment for IS, with fewer damaging side-effects than ACTH. The John Hopkins Centre and other hospitals in the US have already adopted this new use for the diet, based on the outcome of the study.

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