Abstracts

Rationale: Diet and its role in cause and treatment of Epilepsy have been a subject of much speculation. Even today some forms of dietary therapy are in use for treatment of Epilepsy like Ketogenic Diet and other diets with restricted carbohydrate content. The idea of dietary therapy of epilepsy and of its potential role in the etiology of Epilepsy was developed during this time period 1875-1938. The introduction of Diphenylhydantoin in 1938 decreased interest in dietary therapy of Epilepsy. Methods: Extensive review of published literature from 1875 to 1938. Results: An exhaustive review of literature revealed 4 common themes regarding the role of Diet in Epilepsy: High Protein Diets and Epilepsy - Hughlings Jackson first recommended, "not to eat much meat as it was nitrogenized food". Reduction or elimination of meat from the diet was also recommended by Kulp in 1875 and also by Osler. Hammond in 1893 recommended ‘peptonized milk' for children with epilepsy as this form of milk protein is easily absorbed. Rosanoff in 1905 & 1909 explained that diets high in proteins may worsen epilepsy. Fasting and Epilepsy - H. Rawle Geyelin & Marjorie Wheatley reported on Dr Conklin's successful treatment of Epilepsy by fasting in 3 patients in 1921. The investigators then tried this mode of treatment in 26 patients with epilepsy and 20 patients improved with fasting, 3 became seizure free. In 1923 Weeks et al. reported on this same subject and found that 30 out 64 patients stopped having Epileptic seizures. Lennox and Cobb reported in 1928 a similar benefit with fasting, 10 of 27 patients were seizure free during the period of fasting. Talbot et al. showed that all 24 children became seizure free during fasting but seizures resumed later. Water retention and Epilepsy - McQuarrie and Peeler (1931) showed that typical grand mal seizures could be induced within 12-48 hours in epileptic, but not in non-epileptic by giving water at a rate of 2-5 cc/kg of body weight/hour. Though Dehydration was not of any therapeutic value in the treatment of Epilepsy, Fetterman and Kumin (1933). Ketogenic Diet - Based on the biology of starvation in 1921 Wilder at Mayo Clinic described a diet that mimics starvation and causes ketonuria. This diet had a beneficial effect on the control of seizures. In 1927 Talbot et al. described a ketogenic diet that is similar to the protocol followed at many institutions even today. Subsequent studies by Lennox (1928) and Helmholz (1930) showed a definite therapeutic effect of ketogenic diet in the management of seizures. Conclusions: The influence of the dietary modifications on epilepsy therapy developed in this era, 1875-1938, of limited antiepileptic drug availability has left a lasting effect on our current approach to epilepsy therapy. And given the current interest in non-drug treatment of epilepsy a review of the findings of a period when such an interest was a necessity would be very valuable.