Abstracts

The ketogenic diet (KD) is a high-fat, low-protein, very low-carbohydrate diet used in the treatment of medically refractory epilepsy in children. Its anticonvulsant mechanism is still unclear but alterations of fatty acid (FA) levels has been proposed as a mechanism of action. We examined the influence of the KD on FA levels and seizure control., The levels of seventeen FAs in plasma phospholipids were determined before and 1, 6, and 12 months after initiation of the KD in 25 children (mean age 6.3 years) with severe epilepsy. The majority were on a KD ratio of 4:1 (fats:proteins and carbohydrates). After 1 month, the KD was supplemented with polyunsaturated omega-3 FAs by adding fish-oil (4-8 g/day). Seizures were quantified., Highly significant changes in the levels of several FAs were found in relation to the KD. After 1 month on KD significant changes were seen in the levels of 8 FAs, after 6 months on KD in 10 FAs and after 12 months on KD in 12 FAs. Changes were found in the levels of polyunsaturated, monounsaturated as well as saturated FAs. Among others, increases were seen in linoleic acid (18:2 n6) and EPA (20:5 n3) and decreases in arachidonic acid (20:4 n6). The ratio of omega-6 to omega-3 FAs decreased from 7.0 before diet to 4.9 at 12 months after diet start. However, no correlation of FA levels to seizure response was found., The ketogenic diet induced prominent changes in several major plasma fatty acid levels but a correlation to seizure control was not found. A decreased ratio of omega-6 to omega-3 fatty acids was observed which may be of benefit to reduce risks of cardiovascular disease. Further studies are needed on how different diet compositions, in terms of type and amount of various fatty acids, affect blood fatty acid profile, in order to define an optimal diet regime for maximal seizure control as well as minimal cardiovascular risks., (Supported by the Margaretahemmet Association Sunnerdahl Handicap Fund.)