Advertisement

Low glycemic index treatment in patients with drug-resistant epilepsy

  • Se Hee Kim
    Affiliations
    Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children’s Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Hoon-Chul Kang
    Affiliations
    Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children’s Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Eun Joo Lee
    Affiliations
    Division of Dietetics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Joon Soo Lee
    Affiliations
    Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children’s Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Heung Dong Kim
    Correspondence
    Corresponding author. Tel.: +82 2228 2061; fax: +82 2 393 9118.
    Affiliations
    Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children’s Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
    Search for articles by this author

      Abstract

      Objective

      Low glycemic index treatment (LGIT) is a newly developed dietary therapeutic option for epilepsy that is less restrictive than the ketogenic diet (KD). Our objective was to determine the efficacy and tolerability of LGIT.

      Methods

      From March 2014 to February 2015, 36 patients received LGIT at Severance Children’s Hospital. One-year seizure outcomes and side effects were evaluated.

      Results

      A total of 36 patients were assessed. Fourteen were female. Common diagnoses were Lennox-Gastaut syndrome (33%, 12/36) and Dravet syndrome (14%, 5/36). The median age at the initiation of the LGIT was 12.6 years (min. = 1.5, max. = 28, interquartile range (IQR) 8–17). After 3 months of therapy, 20 (56%) patients experienced a 50% or greater reduction in seizure frequency, which was maintained in 19 (53%) patients for 1 year. Two (6%) patients became seizure-free after 3 months of LGIT; they remained seizure-free for 1 year. These two had Dravet syndrome and generalized epilepsy. Only three (8%) patients discontinued treatment within 1 year. Adverse events were rare, and two patients (6%) reported transient diarrhea.

      Conclusions

      LGIT effectively reduced seizure frequency in the present study, although seizure freedom was infrequently achieved. LGIT may be considered as a therapeutic option for patients with drug-resistant epilepsy, particularly those who find KD effective but intolerable.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Brain and Development
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cross J.H.
        • Neal E.G.
        The ketogenic diet–update on recent clinical trials.
        Epilepsia. 2008; 49: 6-10
        • Freeman J.M.
        • Vining E.P.
        • Pillas D.J.
        • Pyzik P.L.
        • Casey J.C.
        • Kelly L.M.
        The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children.
        Pediatrics. 1998; 102: 1358-1363
        • Henderson C.B.
        • Filloux F.M.
        • Alder S.C.
        • Lyon J.L.
        • Caplin D.A.
        Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis.
        J Child Neurol. 2006; 21: 193-198
        • Neal E.G.
        • Chaffe H.
        • Schwartz R.H.
        • Lawson M.S.
        • Edwards N.
        • Fitzsimmons G.
        • et al.
        The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial.
        Lancet Neurol. 2008; 7: 500-506
        • Vining E.P.
        • Freeman J.M.
        • Ballaban-Gil K.
        • Camfield C.S.
        • Camfield P.R.
        • Holmes G.L.
        • et al.
        A multicenter study of the efficacy of the ketogenic diet.
        Arch Neurol. 1998; 55: 1433-1437
        • Kossoff E.H.
        • Zupec-Kania B.A.
        • Amark P.E.
        • Ballaban-Gil K.R.
        • Christina Bergqvist A.G.
        • Blackford R.
        • et al.
        Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group.
        Epilepsia. 2009; 50: 304-317
        • Dressler A.
        • Trimmel-Schwahofer P.
        • Reithofer E.
        • Groppel G.
        • Muhlebner A.
        • Samueli S.
        • et al.
        The ketogenic diet in infants–Advantages of early use.
        Epilepsy Res. 2015; 116: 53-58
        • Cervenka M.C.
        • Henry B.
        • Nathan J.
        • Wood S.
        • Volek J.S.
        Worldwide dietary therapies for adults with epilepsy and other disorders.
        J Child Neurol. 2013; 28: 1034-1040
        • Ye F.
        • Li X.J.
        • Jiang W.L.
        • Sun H.B.
        • Liu J.
        Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis.
        J Clin Neurol. 2015; 11: 26-31
        • Kang H.C.
        • Lee H.S.
        • You S.J.
        • Kang du C.
        • Ko T.S.
        • Kim H.D.
        Use of a modified Atkins diet in intractable childhood epilepsy.
        Epilepsia. 2007; 48: 182-186
        • Miranda M.J.
        • Turner Z.
        • Magrath G.
        Alternative diets to the classical ketogenic diet–can we be more liberal?.
        Epilepsy Res. 2012; 100: 278-285
        • Foster-Powell K.
        • Holt S.H.
        • Brand-Miller J.C.
        International table of glycemic index and glycemic load values: 2002.
        Am J Clin Nutr. 2002; 76: 5-56
        • Kim T.H.
        • Petrou S.
        • Reid C.A.
        Low glycaemic index diet reduces seizure susceptibility in a syndrome-specific mouse model of generalized epilepsy.
        Epilepsy Res. 2014; 108: 139-143
        • Kwan P.
        • Arzimanoglou A.
        • Berg A.T.
        • Brodie M.J.
        • Allen Hauser W.
        • Mathern G.
        • et al.
        Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.
        Epilepsia. 2010; 51: 1069-1077
        • Pfeifer H.H.
        • Thiele E.A.
        Low-glycemic-index treatment: a liberalized ketogenic diet for treatment of intractable epilepsy.
        Neurology. 2005; 65: 1810-1812
        • Kim D.W.
        • Kang H.C.
        • Park J.C.
        • Kim H.D.
        Benefits of the nonfasting ketogenic diet compared with the initial fasting ketogenic diet.
        Pediatrics. 2004; 114: 1627-1630
        • Lee E.
        • Kang H.C.
        • Kim H.D.
        Ketogenic diet for children with epilepsy: a practical meal plan in a hospital.
        Clin Nutr Res. 2016; 5: 60-63
        • Kang H.C.
        • Chung D.E.
        • Kim D.W.
        • Kim H.D.
        Early- and late-onset complications of the ketogenic diet for intractable epilepsy.
        Epilepsia. 2004; 45: 1116-1123
        • Coppola G.
        • D'Aniello A.
        • Messana T.
        • Di Pasquale F.
        • della Corte R.
        • Pascotto A.
        • et al.
        Low glycemic index diet in children and young adults with refractory epilepsy: first Italian experience.
        Seizure. 2011; 20: 526-528
        • Karimzadeh P.
        • Sedighi M.
        • Beheshti M.
        • Azargashb E.
        • Ghofrani M.
        • Abdollahe-Gorgi F.
        Low Glycemic Index Treatment in pediatric refractory epilepsy: the first Middle East report.
        Seizure. 2014; 23: 570-572
        • Larson A.M.
        • Pfeifer H.H.
        • Thiele E.A.
        Low glycemic index treatment for epilepsy in tuberous sclerosis complex.
        Epilepsy Res. 2012; 99: 180-182
        • Muzykewicz D.A.
        • Lyczkowski D.A.
        • Memon N.
        • Conant K.D.
        • Pfeifer H.H.
        • Thiele E.A.
        Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy.
        Epilepsia. 2009; 50: 1118-1126
        • Thibert R.L.
        • Pfeifer H.H.
        • Larson A.M.
        • Raby A.R.
        • Reynolds A.A.
        • Morgan A.K.
        • et al.
        Low glycemic index treatment for seizures in Angelman syndrome.
        Epilepsia. 2012; 53: 1498-1502
        • Martikainen M.H.
        • Paivarinta M.
        • Jaaskelainen S.
        • Majamaa K.
        Successful treatment of POLG-related mitochondrial epilepsy with antiepileptic drugs and low glycaemic index diet.
        Epileptic Disord. 2012; 14: 438-441
        • Kass H.R.
        • Winesett S.P.
        • Bessone S.K.
        • Turner Z.
        • Kossoff E.H.
        Use of dietary therapies amongst patients with GLUT1 deficiency syndrome.
        Seizure. 2016; 35: 83-87