Seizures

Ketogenic Diet Works: Prospective study 51 kids with intractable seizures Rx ketogenic diet. Were having over 10 seizures/wk despite two drugs. Freq decr over 50% in 54%. Five were seizure free at one year. Developed in 1920s and 30-40% had at least 90% decrease in seizures. High fat, very low carbohydrate diet. Using dipsticks to keep ketotic with calorie restriction. Arch Neurol 11/98 55:1433-37

Caloric Restriction May Be Better CR delayed the onset and reduced the incidence of seizures at both juvenile and adult ages and was devoid of adverse side effects. Furthermore, mild CR (15%) had a greater antiepileptogenic effect than the well-established high-fat ketogenic diet in the juvenile mice. The CR-induced changes in blood glucose levels were predictive of both blood ketone levels and seizure susceptibility. CONCLUSIONS: We propose that CR may reduce seizure susceptibility in EL mice by reducing brain glycolytic energy. Our preclinical findings suggest that CR may be an effective antiseizure dietary therapy for human seizure disorders.

Repeat Seiz in Kids: 407 kids f/u 16 yr by Shinnar in Annals Neuro 8/00 found 29%, 27%, 43%, and 46% had a second seiz after 1, 2, 5, and 10 years. Of 182 with second seiz, 72% 3^rd, 59% 4^th, and 29% 10 or more. Decision to Rx individualized depending on frequency and intensity.

Thiamine Helps Dilantin Pts: DB PC 6 mo for 72 pts on phenytoin placebo vs folate 5 mg vs thiamine 50 mg vs. both. No benefit folate but thiamine group did better on Wechsler both verbal and non-verbal. Botez, Montreal, Epilepsy Res ’93;16:157