Can Fat Cure Epilepsy?

One morning in March 1993, film producer Jim Abrahams ("Airplane," "Naked Gun") was pushing his 1-year-old son, Charlie, in the swing at their Santa Monica, Calif., home when the boy's head dropped suddenly and his right arm jerked skyward. Within weeks the child was suffering epileptic seizures-- 30 to 40 a day--and his parents were searching desperately for help. They tried drugs like phenyl barbital and Dilantin. They tried homeopathy, faith healing and brain surgery. But the seizures continued. Eight months and $100,000 later, Abrahams heard about the "ketogenic diet," a therapy based on fasting and extremely high-fat meals. The leading proponent is Dr. John Freeman, a pediatric neurologist at the Johns Hopkins Medical Institutions, so the Abrahamses headed for Baltimore over Thanksgiving to try it. By Christmas, the child was off drugs and seizure-free. Nearly two years later, he still is.

Many experts remain skeptical--but for the 56,000 American kids whose epilepsy doesn't respond to other treatments, the ketogenic diet offers a glimmer of hope. At 17 medical centers around the country, doctors now offer it to any child under 14 who has failed two drugs, suffers at least three seizures a week and has parents willing to make a two-year commitment. At Hopkins, Freeman and his colleagues have treated 200 kids since 1990 and are now trying the regimen in adolescents. Most of their patients improve on the diet, and Freeman says 20 to 25 percent end up seizure-free.

The treatment begins with a five-day hospital stay. While cutting back on medication, the patient goes on a two-day fast, followed by three days of increasingly fatty meals. For Jason Simon, one of four teens who entered the Hopkins program this month, that meant giving up his favorite breakfast cereal for a shake made of eggs, cream, oil, saccharine and vanilla. Participants continue to down this brew throughout the two-year treatment, but they eat solid food as well. Their meal plans provide $.5 parts fat to one part protein and carbohydrate (chart), while holding calories constant to prevent weight loss or obesity. As the body burns all that fat, it produces molecules called ketones, which seem to inhibit seizures.

No one knows just why the treatment works, and some experts suspect there's less to it than meets the eye. "The diet is a reasonable thing to try when nothing else has worked," says Dr. William Theodore, chief of clinical epilepsy at the National Institute of Neurological Disorders and Strokes. "But a certain amount of reserve needs to go with it." Freeman himself cautions that the diet can lead to gout and kidney stones unless carefully monitored. Over time, it could also promote heart disease. Yet Freeman believes the ketogenic diet could eventually become an alternative to conventional treatment, not just a backup. Antiepileptic drugs are themselves highly toxic, he observes; some prevent seizures only by leaving kids so sedated they can barely function. Living on fat has obvious drawbacks. But for many epileptics, the alternatives can be worse.

Omelet, which includes

1/2 eggs,

1 tbsp. cream,

3 tbsp. butter.

Cafe au lait with 2 oz. cream.

Chef salad, which includes

1 oz. American cheese,

1 oz olive off.

Whipped-cream desert with 2 1/2 oz cream

"0" calorie diet soda, 6 oz.

Baked chicken breast, which includes

2 1/2 oz chicken breast,

3 tbsp mayonaise Root-beer float with

2 1/2 oz cream

SOURCE: PEDIATRIC EPILEPSY CENTER, JOHNS HOPKINS MEDICAL INSTITUTIONS.

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