26 March marks Lavender Day, or International Epilepsy Day - the most common nervous system disease in children. Approximately 75% patients develop the disease before the age of 19, with the highest incidence seen in infancy[1]. In almost one in three patients[2], despite medication, the condition does not improve, seizures persist and children's quality of life deteriorates. A chance for a normal life for these individuals is offered by the ketogenic diet.
- For more than 100 years, the mainstay of epilepsy treatment has been the use of pharmacotherapy Unfortunately, despite significant advances in medicine and the emergence of many new anti-epileptic drugs, we still fail to control epileptic seizures in 20-30 per cent of patients in this way - recalls Dr Magdalena Dudzińska. In such situations, we are dealing with drug-resistant epilepsy. In a child who has so far been correctly treated with 2-3 anti-epileptic drugs without satisfactory effect, a ketogenic diet should be considered - explains Dr Magdalena Dudzinska, MD, paediatric neurologist.
The ketogenic diet is a high fat, low carbohydrate diet with age-appropriate amounts of protein and calories in the meals consumed. When a child is on a traditional diet, their body uses glucose (a carbohydrate) as its primary source of energy. The ketogenic diet, by providing a large amount of fat and a negligible amount of carbohydrates, mimics the body's state during starvation. The body then undergoes metabolic changes that cause it, after using up its own glucose reserves (which occurs within 12-24 hours of cessation of feeding), to reach for fat reserves, treating them as a source of energy. Chemical transformations result in the formation of fatty acids and ketone bodies: acetone, acetoacetate and β-hydroxybutyric acid, which penetrate well into the central nervous system and there replace glucose in metabolic processes including those related to energy production in nerve cells. By a number of complex mechanisms, this ultimately leads to inhibition of epileptic discharges in the brain and a reduction in the number or even complete cessation of epileptic seizures, as well as an evident improvement in the quality of function.
- The ketogenic diet is an internationally recognised non-pharmacological treatment for drug-resistant epilepsy in children. It is very effective, with approximately 60% children with drug-resistant epilepsy having more than half the number of seizures, approximately 30 % having a seizure reduction of more than 90% and 20-10% having a complete cessation of seizures. In about 80% children, irrespective of the degree of seizure reduction, functional improvement is noted and in about 30% it is possible to discontinue antiepileptic drugs. The ketogenic diet is not a diet, but a recognised method of epilepsy treatment that must be followed under the close supervision of a neurologist and an experienced dietician, never 'on your own'. The composition of the diet must be precisely calculated individually for each child according to age, weight, activity, and type of condition. The ketogenic diet, especially in young patients (up to 3 years of age), children with significant neurodevelopmental disorders and those fed through a PEG (percutaneous endoscopic gastrostomy) can also be carried out on the basis of food for special medical purposes - adds Dr Dudzinska.
The ketogenic diet is poor in cereal products and significantly reduces the intake of fruit and vegetables as well as dairy products, which can lead to various deficiencies in the child's body. It is therefore necessary to take mineral and vitamin supplements, and sometimes other measures that are recommended and prescribed by the treating doctor. The ketogenic diet may seem difficult at first - to be effective, the recommendations of the doctor and dietician must be strictly followed. The fixed proportions of fats to carbohydrates and proteins combined in the diet must be maintained in each dish and the meals, like the anti-epileptic drugs, spread evenly throughout the day. As carers gain experience and understanding of the principles of the ketogenic diet, this becomes easier. The experience of parents using this treatment method with their children proves that it is worth trying.
– Olive was diagnosed with epilepsy at the age of two. Despite the introduction and trying of many medications, the seizures did not stop. For 4 years no drug treatment worked. We did not see any progress. In June 2017, in spite of our fears, after consulting a neurologist, we decided to try ketogenic diet therapy and after some time of using it, we had a real breakthrough. Olive's health and well-being improved significantly, the seizures practically stopped. Previously, during drug treatment, every stimulus triggered a seizure. Before starting the diet, the child had difficulty climbing stairs and was unable to descend them. The daughter was experiencing problems with food intake. Psychomotor development was stagnant and instead of reducing the number of seizures, the medication was hindering Olive's normal development. We started introducing the ketogenic diet with the help of medical nutrition. This made it much easier for us to prepare meals, as we knew how important it was to strictly follow the menu laid down by the doctor. Thanks to the ketogenic diet, Olive today speaks, reads, counts, writes and was able to go to a normal school. She is doing very well. Last summer she learnt to ride a bike on her own. Our story is proof that if drug treatment doesn't work, it's worth trying - and it's a good thing. says Ms Monika, mother of 10-year-old Olive.
[1] https://dieta-ketogenna.pl/blog/rola-diety-ketogennej-w-leczeniu-padaczki-lekoopornej
[2] Dudzinska M.: The ketogenic diet-when antiepileptic drugs do not help. PZWL.2015