High-fat, low-carb plan may work when other treatments fail, study says
THURSDAY, Jan. 31 (HealthDay News) -- Adults with epilepsy who have failed other treatments may be able to dramatically reduce their number of seizures by following a modified Atkins-like diet, Johns Hopkins researchers report.
The high-protein, low-carbohydrate diet has already been shown to be valuable in controlling seizures in children, and now results from a small study suggest that the diet also works for adults.
"There are a lot of adults with very bad seizures. There are a lot of adults who have failed medicines and are not candidates for other treatments," said lead researcher Dr. Eric H. Kossoff, an assistant professor of neurology and pediatrics at Johns Hopkins School of Medicine.
For the study, Kossoff's team gave the diet to 30 adults who had unsuccessfully tried at least two anti-convulsant drugs and had an average of 10 seizures a week. The eating plan restricts patients to 15 grams of carbohydrates a day. Most of the calories come from fats such as eggs, meats, oils and heavy cream. In addition, patients are free to eat as much protein and no-carb drinks as they want.
"There was good news and bad news," Kossoff said. "The good news was it worked. The bad news it was tough. About 30 percent of the patients stopped the diet. This happened even in patients who had good seizure control who thought the diet was still too tough to do."
After a month on the diet, half the patients reported suffering 50 percent fewer seizures. At three months, about one-third of the patients cut the frequency of seizures by half.
However, by three months, one-third of the patients had dropped out of the study because they found the diet too restrictive, Kossoff said.
The diet's side effects, such as increases in cholesterol or triglycerides, were mild, Kossoff noted.
After six months on the diet, 14 patients continued with it, even though the study was over, he said.
The findings are published in the February issue of the journal Epilepsia.
No one knows how the diet works to reduce seizures, Kossoff said. And, most people find it too hard to follow, so it's probably not a long-term solution for most people with epilepsy, he added.
He also noted that patients who go on the diet need to continue with it, perhaps for years to keep seizures under control.
But Kossoff thinks the diet can be simplified to make it easier to follow. "We are looking at less time in the clinic and fewer restrictions and without a dietitian," he said.
Dr. Gholam Motamedi, director of the epilepsy service at Georgetown University Hospital, thinks the diet can be useful for patients who have no other options.
"The study is promising, especially given that patients with refractory epilepsy in particular -- those who are not surgical candidates -- are left with not much hope," he said.
Normally, the plan for these patients is to try a combination of different drugs or to use vagus nerve stimulation, but none of these options offers much hope of seizure control, Motamedi said.
"Therefore, having another modality available is always welcomed by the neurologists," he said. "It also encourages basic research looking for insight to the underlying reasons for epilepsy."
For more on epilepsy, visit the Epilepsy Foundation.
SOURCES: Eric H. Kossoff, M.D., assistant professor of neurology and pediatrics, Johns Hopkins University School of Medicine, Baltimore; Gholam Motamedi, M.D., associate professor of neurology, director, epilepsy service, Georgetown University Hospital, Washington, D.C.; February 2008, Epilepsia
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