Diet can prevent seizure!
Many drugs are used to prevent seizure. Some of them are costly and have severe side effects, but now diet can also prevent seizure! Sometimes diet is better than the drugs even! A diet called "Ketogenic diet" does this excellent job. The ketogenic diet is a high fat, adequate protein and low carbohydrate diet. It is primarily used to treat difficult-to-control (refractory) epilepsy in children. Recent recommendation for starting ketogenic diet is failure to improve in spite of adequate trial of two anti-convulsants, as the chance of other drugs succeeding is only 10%. Ketogenic diet was first introduced by John Hopkins University, USA. Now many countries use this. Commercial form of this ketogenic diets ("Atkin", "Ketocal") are available in developed country which is very costly and not available in Bangladesh. But we are lucky enough that doctors of Dhaka Medical College Hospital recently prepared ketogenic diet with locally available foods. Dr Narayan Chandra Shaha, an associate professor of Paediatrics of Dhaka Medical College Hospital (DMCH) with the help of Prof M Ekhlasur Rahman and Professor Abid Hossain Mollah has done this tremendous job. Dr Afroz and Dr Sayeed also assisted Dr Narayan. Recently they have successfully treated few patients with this new diet. The ketogenic diet mimics aspects of starvation by forcing the body to burn fat rather than carbohydrate. Normally, the carbohydrates in food are converted into glucose, which is then transported across the body and is particularly important in fuelling the brain. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. Ketone bodies have anticonvulsant effects. The diet has just enough protein for body growth and repair and sufficient calories to maintain the correct weight for age and height. The "classic" ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by eliminating foods high in carbohydrates (starchy fruits and vegetables, bread, pasta, grains and sugar) while increasing the consumption of foods high in fat (cream and butter). The potential use of the diet as a treatment for medical conditions other than epilepsy is, as of 2008, still at the research stage. In 2008, a randomised controlled trial showed a clear benefit for treating refractory epilepsy in children. This added weight to conclusions drawn from the many earlier uncontrolled trials of the ketogenic diet's efficacy and safety, which already provided sufficient evidence to recommend clinical use. In children with refractory epilepsy, the ketogenic diet is more likely to be effective than trying an alternative anticonvulsant drug. There is some evidence that adults with epilepsy may benefit from the diet and that a less strict regime, such as a modified Atkins, could be effective. The diet could be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy (doose syndrome), severe myoclonic epilepsy of infancy (dravet syndrome), rett syndrome and tuberous sclerosis complex. Because the ketogenic diet radically alters the metabolic state of the body, it is a first-line therapy in children with certain congenital metabolic diseases, but in others, it is an absolutely contraindicated. Calculating the ketogenic diet is three parts science and one part art. The art part is a combination of common sense, empathy and intuition. In each case, a child's individual needs must be taken into account. After treating with ketogenic diet, lack of energy and lethargy are common but disappear within two weeks. At around two years on the diet, or after six months of seizure freedom, the diet may be gradually discontinued over a two- to three-months period. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions. Children who discontinue after achieving seizure freedom have about a 20% risk of seizure recurrence. The length of time until recurrence is highly variable but averages two years. Ketogenic diet is now the treatment of choice for intractable epilepsy in developed world. They use it for many years. But we need to prepare ketogenic diet by locally available foods. It is a very hard task but we prove that it is not impossible. As only few cases of intractable epilepsy are managed with ketogenic diet, still there may be some portion to be improved. We hope that in future we can manage better with ketogenic diet and make more palatable and tolerable meal with locally available foods. The writer is an Assistant Registrar at the Department of Paediatrics of Dhaka Medical College Hospital. E-mail:shimulsayeed@hotmail.com
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