Ketogenic Diet for New-Onset Absence Epilepsy
Ketogenic Diet for New-Onset Absence Epilepsy
The ketogenic diet is a medical therapy for epilepsy that is used nearly predominantly for
 refractory epilepsy (after 2-3 drugs have been tried and failed). However, there is both
 published evidence for first-line use (infantile spasms, Glut1 deficiency syndrome) and also
 anecdotal experience (families choosing to change the child's (or the family' own) diet
 rather than use anticonvulsant medications). Childhood absence epilepsy (refractory) has been
 published as being responsive to ketogenic diet therapy by the investigators' group
 previously. This is a small, prospective, 3 month trial to assess if using a modified Atkins
 diet is a feasible and effective option for new-onset childhood absence epilepsy. The
 investigators will compare to a group of children in which the parents have declined and
 chose to start anticonvulsant medications.
The ketogenic diet has been in continuous use since 1921 for children and adult with
 medically-refractory epilepsy. One of the major unanswered questions is whether it would be
 as effective for children with new-onset epilepsy. Although logically, this would be the
 case, it remains to be shown in clinical trials. Additionally, it is much easier to take a
 medication than to change dietary habits and there is doubt whether families would truly wish
 to try dietary therapy first (or stay on dietary therapy if not effective for a 6 month trial
 period).

 There is limited published evidence supporting the use of the ketogenic diet as a first-line
 therapy for infantile spasms, myoclonic astatic epilepsy, and in some situations where a
 family member had success and the family wishes to start it first. However, these are
 relatively rare conditions. The emergence of the modified Atkins diet as an outpatient,
 quickly-initiated, non-fasting approach since 2003 has changed the concept of dietary therapy
 towards a much less restrictive, potentially emergent therapy. In this way, using dietary
 therapy could potentially be started before medications for a willing family.

 The use of dietary therapy (including the modified Atkins diet) for childhood absence
 epilepsy goes back decades, but was recently profiled in a review article from the
 investigators' group. In this publication, 17 studies were identified, and 69% of 133
 children with refractory childhood absence epilepsy had a >50% seizure reduction and 34% were
 seizure-free. At the investigators' center, 21 children as of 2011 had been treated with
 dietary therapy with 19% seizure-freedom. The question of whether results would be similar
 (or better) for children with new-onset absence epilepsy was unanswered.

 The standard treatments for childhood absence epilepsy (ethosuximide, valproate, lamotrigine)
 are effective in ~50% of children by 16-20 weeks. However, side effects exist and include
 stomach upset, inattention, mood disturbance, rash, liver function test abnormalities, and
 fatigue. Families at times do ask about avoiding treatment completely, especially as this
 epilepsy usually resolves in puberty and convulsions only occur in 20% (most children have
 brief staring spells only). In addition, families do also ask about "nonpharmacologic"
 treatment, but to date the investigators have not recommended it due to lack of data.

 This study will have 20 children in each arm (diet and drug) with ability to crossover.
 Parents with a child with new-onset absence epilepsy will choose between the two therapies.
 Visits will be at baseline, 1 month and 3 months. EEG, labs and clinic visits will be paid by
 the parent's insurance (not free).
Inclusion Criteria:

 -  Children ages 3-12 years at seizure onset with classic childhood absence epilepsy
 clinically.

 -  Normal intellect or mild disability

 -  EEG with confirmed 3/second spike-wave discharges, usually with hyperventilation

 -  Daily reported absence seizures.

 -  Generalized convulsions allowed

 Exclusion Criteria:

 -  Previous treatment with any anticonvulsant drug

 -  Previous use of a ketogenic dietary therapy for epilepsy or any other condition

 -  Glut1 deficiency syndrome

 -  Metabolic disorder known that would preclude dietary therapy

 -  Dietary restrictions for which a high fat, low carbohydrate diet would be precluded.

 -  Prior history of epilepsy (febrile seizures allowed)

 -  Unwilling to consent to study procedures or return for visits