Seizures decrease rapidly after fasting: preliminary studies of the ketogenic diet

Arch Pediatr Adolesc Med. 1999 Sep;153(9):946-9. doi: 10.1001/archpedi.153.9.946.


Objectives: To evaluate the change in atonic or myoclonic seizures associated with the Lénnox-Gastaut syndrome during the initiation of the ketogenic diet, and to describe the development of a blinded crossover study of the efficacy of the ketogenic diet.

Design: A before-after trial.

Setting: The Johns Hopkins Hospital, Baltimore, Md.

Patients: Change in clinical seizure frequency was examined in 17 consecutively treated patients with atonic or myoclonic seizures. In a few patients, a 24-hour ambulatory electroencephalogram was obtained before and after diet initiation. We demonstrated the ability to manipulate the ketosis induced by fasting with the addition of glucose (dextrose) in 1 patient.

Interventions: Children fasted for 36 hours, and the diet was gradually introduced over 3 days. Parents were instructed to keep a baseline seizure frequency calendar for the month before the initiation of the diet. These calendars continued to be maintained as the diet was initiated.

Main outcome measure: Seizure decrease from baseline.

Results: The atonic or myoclonic seizures decreased in these children by more than 50% immediately. Using a 24-hour ambulatory electroencephalogram, we documented that the seizures reported by a parent represent only a fraction of the electroclinical events; the technique could be used to measure the profound decrease in electrically documented seizures. Ketosis was eliminated with glucose, 60 g/d.

Conclusions: It is feasible to evaluate the ketogenic diet's efficacy in atonic or myoclonic seizures in a blinded, crossover study. The diet can be manipulated on a short-term basis in a blinded manner, and ketosis can be achieved or eliminated.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child, Preschool
  • Electroencephalography
  • Epilepsies, Myoclonic / diet therapy
  • Epilepsy, Generalized / diet therapy*
  • Fasting / physiology*
  • Humans
  • Ketosis*
  • Pilot Projects
  • Prospective Studies