Difficult-to-Treat Epilepsy May Be Controlled With Diet

By: Maysaa Basha, M.D., Wayne Health/WSU Associate Professor of Neurology, Epilepsy Division Director, and Elise Wiersma, MS, AGACNP-BC, RN, RD

Recently, many people have become familiar with the ketogenic (“keto”) diet as a weight loss measure. The ketogenic diet has been used for almost a century in the treatment of epilepsy – but it looks very different from the keto diet you may have seen on the internet.

The ketogenic diet for epilepsy is very strict and severely restricts carbohydrates, replacing them with fat.  This reduction in carbohydrates forces the body into a metabolic state called ketosis, helping the body to burn fat.

Several theories have been proposed as to how ketosis helps to control seizures, including: altering brain pH which decreases excitability; directly inhibiting effects of the ketone bodies; shifting amino acid metabolism to increase inhibitory GABA (a neurotransmitter in the central nervous system); and changing production of ATP (an organic compound that provides energy to cells) to make neurons more resilient.

Regardless of how the keto diet works, it is important to note that it is largely reserved as a treatment for children with epilepsy, and requires very careful balancing of macronutrients, including weighing food and close monitoring for potential side effects. In addition, a hospital stay is typically required to start the diet.

A good alternative to the keto diet which has shown promise as an epilepsy treatment is the Modified Atkins Diet. It is more liberal and better tolerated, especially for adults.  Several studies have shown benefits for seizure reduction (although not as effective as the ketogenic diet). The Modified Atkins Diet favors fat intake and permits fewer carbohydrates compared to the traditional Atkins diet. In addition, fluids aren’t restricted, fats and foods are not weighed or measured, and there is no restriction of proteins.

Wayne Health offers a specialized Modified Atkins Clinic for the treatment of epilepsy that is led by Elise Wiersma, R.N., a nurse practitioner with specialized experience in epilepsy and nutrition. To learn more about the clinic, call 313-745-4275.