Dietary Management Of Paediatric Epilepsy

INTRODUCTION

Epilepsy is a neurological disorder with frequent onset of seizures or fits with uncontrolled muscular movements. Mostly, the children are affected much with the disorder as per world epidemiological data. According to some research studies from India, the incidence rate of epilepsy is 27 per 1 lakh pediatric population, which is a worrisome situation for the country.  The main causes of pediatric epilepsy are genetic, head injury, unsuccessful neurosurgical operation, and chronic neurological infections. Anti-epileptic drugs (AEDs) are the regular treatment option for the disease, but the failure of 3 consecutive AEDs is diagnosed as uncontrolled or refractory epilepsy and can only be managed by high-fat Ketogenic diet.

KETOGENIC DIET

KD is a high fat, adequate protein, least carbohydrate, ratio specific and calculative diet, highly customized for each individual. The regular pattern of the food pyramid is – 65% carbohydrate, 15% protein, and 20% fat. The ketogenic diet is exactly opposite in composition and contains 80% fat, 15% protein, and only 5% carbohydrate.  Biochemical explanation of seizure onset confirms that  glucose is the cause of seizure onset. The mode of action of Ketogenic diet lies on the fact that, for energy production, instead of glucose, ketone bodies are used, which are produced from excess fat and seizure frequency and types are reduced gradually. Ketone bodies are also neuroprotective by preventing nerve health by several means.

TEAM APPROACH:

The ketogenic diet is highly scientific and accurate precision is recommended in calculating the diet. For patients with uncontrolled epilepsy, the diet is treated as medicine and should be used in a prescribed manner. A team of a qualified and trained neurologist, dieticians, psychologists and nurses is a key factor for the management of uncontrolled or refractory epilepsy. A detailed history of the patient is taken and line of treatment is determined for each case. Total intake of calorie, carbohydrate, protein and fat is determined from the current height, current body weight, ideal body weight, blood protein and personal liking-disliking of the patient.  Dietary approach has two distinct steps –

1. Complete washout of carbohydrates before starting the diet and reaching 4+ urine ketone.
2. Determination of the ratio (Fat:Carbohydrate+Protein) and calculating the diet. After reaching 4+ urine ketone, the ketogenic diet has to be implemented immediately to avoid vomiting and nausea in the patients.

As per the progress in seizure control, the ratio, total calorie, amount of protein and other parameters are fine tuned for the best result. Choice of fat is also customized for each patient and as per their convenience.

CAUTION:

Using ketogenic diet by own is not at all recommended as along with the composition of the diet, amount specificity is most important for the best suitable result and to avoid the adverse effect. The diet is highly personalized, so general guideline for uncontrolled pediatric epilepsy is not available as well as not suggested. Other than uncontrolled epilepsy, patients with drug-controlled epilepsy, can intake regular normal diet along with care and attention from the family. Qualified neurologist, trained dietician, skilled psychologist, EEG specialist, and nurse are mandatory to plan and execute a ketogenic diet.