Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy

Abstract

SUMMARYPurpose: To report the efficacy, safety, and tolerability of the low glycemic index treatment (LGIT) in pediatric epilepsy. Methods: A retrospective chart review was performed on patients initiating the LGIT at the Massachusetts General Hospital between January 2002 and June 2008. Demographic and clinical information including seizure type, baseline seizure frequency, medications, blood chemistries, side effects, and anthropometrics were collected. Initiation of the LGIT was done in an outpatient setting. Patients were educated by a dietitian to restrict foods with high glycemic index and to limit total daily carbohydrates to 40-60 g. Change in seizure frequency was assessed at 1-, 3-, 6-, 9-, and 12-month follow-up intervals. Results: Seventy-six children were included in the study. Eighty-nine percent had intractable epilepsy ( ‡3 antiepileptic drugs). A greater than 50% reduction from baseline seizure frequency was observed in 42%, 50%, 54%, 64%, and 66% of the population with follow-up available at 1, 3, 6, 9, and 12 months, respectively. Increased efficacy was correlated with lower serum glucose levels at some time points, but not with b-hydroxybutyrate (BOHB) changes or ketosis status at any time point. Only three patients reported side effects (transient lethargy). Blood urea nitrogen (BUN) was elevated in approximately one-third of follow-up laboratory studies. No significant changes were seen in body mass index (BMI) or BMI z-score at any followup interval. The most cited reason for treatment discontinuation was the restrictiveness of the diet, in 18 patients (24%). Conclusion: The LGIT was associated with reduced seizure frequency in a large fraction of patients, with limited side effects.

Ketogenic diets, mitochondria, and neurological diseases

“…In recent years, there has been an explosion in clinical use of the KD and of its variants ( 29,30 ), as well as in scientifi c interest regarding the mechanisms underlying their action ( 14,31 ). Even beyond this resurgence in popularity for epilepsy, the diet has been increasingly found to exert protective effects in a variety of neurological diseases ( 3,4 ) and new mechanistic insights have steadily emerged.…”

Dietary Treatments for Epilepsy: Why is this So Hard for Us to Swallow?

“…Even the less restrictive LGID has shown similar efficacy results in children and adult populations (4,5). These results are comparable to the efficacy of any medication treatment; which makes it hard to understand why the DTE are not more widely recommended to our patients?…”

Food science: Fat chance

“…In 2005, the low-glycaemic index treatment (LGIT) came from observations that patients on a ketogenic diet had extremely stable glucose levels 6 . In addition to high fat, the LGIT includes only carbohydrates with a glycaemic index lower than 50, which means that these foods do not tend to increase blood glucose levels.…”