Ketogenic therapy as a response to difficult-to-control epilepsy

This therapeutic alternative achieves a significant response in a high percentage of patients, both children and adults.

The British Hospital created a Ketogenic Therapy Center, specialized in addressing cases of epilepsy that are difficult to control (that do not respond adequately to drug treatment) and that are not candidates for surgery. This therapeutic alternative achieves a significant response in a high percentage of patients, both children and adults.

This center has a team made up of the head of the Department of Neurology, Professor and Doctor Alejandro Scaramelli, by Doctor Andrea Avellanal, a neurologist specializing in Ketogenic Therapy, by Natalia Vique, a nutritionist specializing in Ketogenic Diet, and by the head of the Department of Neuropediatrics, Professor and Doctor Gabriel González.

It is a therapeutic modality based on a special diet, characterized by a high lipid content and a low carbohydrate intake which leads to the production of ketone bodies. “It is not just a diet, but a metabolic therapy, in which the usual fuel used by our brain is replaced by an alternative, which are ketone bodies. They determine a state called ketosis which must be maintained in a sustained manner and which is what leads to better control of seizures. The treatment is rigorous, involves a series of precautions and must be carried out by a multidisciplinary team specialized in it,” Scaramelli explained.

“It is an established treatment, universally accepted, which is increasingly used in developed countries due to its high efficacy,” he said.

Its main use is for cases of refractory or drug-resistant epilepsies. Its application is also being studied in some types of brain tumors and in different neurodegenerative and autoimmune diseases. With this therapy between 50% and 70% of patients with difficult-to-control epilepsies show a significant reduction in the frequency of seizures, with up to 20% to 30% of cases becoming seizure-free. The treatment consists of two phases: the initial phase and the maintenance phase. In the first phase, which lasts three months, the response and tolerance to the diet are assessed. If the patient responds and tolerates it well, he or she moves on to the maintenance phase, which lasts approximately two years.

Patients are previously assessed by the team to determine whether they are indicated for the therapy, to rule out contraindications and to provide them with more detailed information on the approach proposed to them. “Strict adherence to the diet must be maintained for its optimal effectiveness, and the relative proportion of nutrients and the number of calories must be met, adjusting to the requirements of each patient,” he explained.

Team members carry out close monitoring and follow-up, in order to detect and prevent complications, in addition to ensuring optimal ketosis (level of ketone bodies measured in urine) and to rule out different causes of possible imbalances.

“Many patients even have to stop taking antiepileptic drugs or reduce their doses, thus reducing their side effects. In addition to the control of seizures, they often show improvements in other areas such as sleep, behavior, attention and memory," he said.