Ketogenic Diet May Reduce Seizures In Infants With Epilepsy
Submitted by News Staff on 8 September 2008 - 3:00am. Public Health
Infantile spasms are a severe and potentially devastating epilepsy
condition affecting children aged typically 4-8 months. Sometimes
called West syndrome because it was first described by Dr. William
James West in the 1840s, they consist of a sudden jerk followed by
stiffening. Each individual seizure usually lasts no more than a
second but they occur close together and are most common just after
waking up.
In a new study appearing in Epilepsia, researchers have found that the
ketogenic diet, a high fat, low carbohydrate diet more traditionally
used for intractable childhood epilepsy, is an effective treatment for
this condition before using drugs.
The study is the first description of the ketogenic diet as a first-
line therapy for infantile spasms.
ACTH and vigabatrin, medications that are the commonly-used first
treatments worldwide, can have potentially-serious side effects such
as hypertension, gastric ulceration, cortical atrophy, and visual
field constriction. ACTH, though it is effective in 60-70 percent of
cases, also costs more than $80,000 for a one-month supply and
vigabatrin is not currently available in the U.S. Both drugs have
about a 30-40 percent recurrence rate of spasms as well. Other
therapies are not yet proven.
"We decided to review our experience at Johns Hopkins using the
ketogenic diet to treat infantile spasms before medications were tried
and compare this to our use of ACTH over the same time period," says
Eric Kossoff, M.D, a pediatric neurologist at Johns Hopkins Hospital
and lead author of the study. "We knew that the ketogenic diet worked
well for difficult-to-control infantile spasms, so we thought it would
also be effective earlier."
If the diet stopped the spasms, infants were kept on it for usually 6
months. The diet worked in 8-of-13 infants within approximately one
week. Only 1-of-8 had recurring spasms, and that infant was controlled
again with the addition of topiramate to the diet. Side effects were
fewer than ACTH in this series and the recurrence rate was also lower
with the diet. In the 5 patients in which the diet did not work, ACTH
was started immediately; it worked quickly in 4 of the 5 infants. ACTH
did lead to a normal EEG quicker, but long-term developmental outcomes
were identical.
As a result of the findings, the ketogenic diet is now one of the
typically-offered first-line therapies for new-onset infantile spasms
at Johns Hopkins. Other hospitals are beginning to use the ketogenic
diet similarly. The researchers hope this novel use of the ketogenic
diet may be the first step in finding another treatment to control new-
onset infantile spasms.
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Tom
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