Abstracts

The ketogenic diet is known to be a highly effective treatment for intractable pediatric epilepsy, but it can be difficult for children to comply with the strict diet regimen over a long period of time. We have therefore looked for alternative methods of providing seizure control through dietary changes. One metabolic consequence of the ketogenic diet is that the patients maintain low normal blood glucose levels, which remain fairly stable throughout the day. This can also be accomplished through a low glycemic index diet (LGID), which limits foods that elevate blood glucose, without limiting protein or total calories. We are investigating the possibility that a LGID can have a significant impact on seizure frequency. Six patients were initiated on a low glycemic index diet: four after failing long term compliance with the ketogenic diet, and two prior to initiation of a ketogenic diet. A retrospective chart review was performed for demographic and clinical information, including seizure frequency by parental report. All six patients treated with a LGID experienced a significant reduction in seizure frequency.
The six children ranged in age from 6 years to 15 years, and included 4 males and 2 females. Three children had absence seizures, two children had mixed seizure disorders including one with Doose[apos]s syndrome, and one child had partial complex seizures. The etiology for 5 of the six patients is unknown; one child had a frontal encephelocele. All six patients had refractory epilepsy prior to initiating dietary treatment and all had failed between 6-10 anticonvulsants prior to diet initiation.
One of the patients, a 12 year old male had up to 20 absence seizures per hour prior to initiating the classic ketogenic diet, and his seizures had not responded to 7 medications. After starting the ketogenic diet, his seizures decreased to 3-4 per day. Unfortunately he was unable to maintain compliance to the diet after one year and was transitioned to a low glycemic index diet. Subsequently, he has continued to have seizure activity with 10-20 seizures per day, and the seizure frequency fluctuates depending on his carbohydrate intake.
Another patient, a 6 year old male diagnosed with Doose[apos]s syndrome had 13-14 seizures per day prior to dietary treatment. He was started on a low glycemic index diet prior to initiating the ketogenic diet. While on the LGID, his seizure frequency dramatically decreased. Although the ketogenic diet is a highly effective treatment for intractable epilepsy in childhood, it can often be difficult for children to adhere to due to its dietary retrictions. In our experience, the low glycemic index diet has proven to be well tolerated and effective for several children, and may be an alternative to the ketogenic diet in providing seizure control.