Some science behind the scenes

Epilepsy and diet

An understanding that dietary problems could result in epilepsy was discovered way back in 1921.  Rollin Woodyatt reviewed the research on diet hoping  to obtain the benefits of fasting on both epilepsy and diabetes in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ‘ketogenic diet’ as a treatment for epilepsy.  The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet.

Given that calcium  and sodium in particular are found in carbohydrates and salt, there is an obvious chance of imbalance here if you have too many carbohydrates and too much or even too little salt.  Whilst the ketonic diet addresses the calcium problems, it does not address the salt problems. 

Wilder's colleague, paediatrician Mynie Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories.  The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. Clifford Barborka, also from the Mayo Clinic, reported that 56% of older patients improved on the diet and 12% became seizure-free.

It is clear, however, that some of the understanding of how the diet helps has been lost and the diets now being used are vitamin deficient………….

The effect of the classical and medium chain triglyceride ketogenic diet on vitamin and mineral levels - Christodoulides SS et al; UCL-Institute of Child Health & Great Ormond Street Hospital for Children NHS Trust, London,

The risk of nutritional deficiency in children on restrictive dietary treatments and a lack of ketogenic diet (KD)-specific UK supplements raises concerns about micro-nutrient status.

Vitamin A, E, zinc, selenium and magnesium levels were therefore examined in children with intractable epilepsy  ……Data were available from 91 children…….

Changes in plasma vitamins A and E and the decline in magnesium status after months of KD treatment suggest that micro-nutrient status may be sub-optimal in  this group and that available formulations for KD supplementation may need reviewing.

From the point of view of the potassium deficiencies there seems to be a clear link with epilepsy and potassium imbalances.

Sleep manifestations of voltage-gated potassium channel complex autoimmunity. Cornelius JR et al; Center for Sleep Medicine, College of Medicine, Mayo Clinic, Rochester USA

To identify the spectrum of sleep disorders associated with [malfunctioning of] voltage-gated potassium channel (VGKC) complexes.

….In 14 patients (93%), serious sleep disturbances were identified (insomnia, dream enactment behaviour, suspected nocturnal epilepsy, and hypersomnia). Severe insomnia occurred in 9 patients (60%), regardless of neurologic presentation.

……4 patients had complete absence of sleep.

Sleep disorders are cardinal manifestations of VGKC complex [problems].