Monthly Case

A 7-year-old girl suffers since her 3rd year of life from daily episodes with impaired consciousness, these are accompanied by discrete oral automatisms. Duration of these presumably atypical absence seizures is 15-20 sec. The child additionally suffers from a moderate global developmental disorder, she attends a school for children with special needs. The cause for epilepsy and mental retardation is elusive, cMRT demonstrates some slight global atrophy, cerebrospinal fluid examination is normal.

So far, the girl has been treated with six different antiepileptic drugs. The current treatment regimen with oxcarbazepine and levetiracetam did not result in obvious reduction of seizures frequency.

We discussed with the parents the therapeutic option of ketogenic diet that is well-know in the treatment of epilepsy for more than 80 years. This diet is characterized by high fats and low carbohydrates which lowers the glucose level dramatically. As compensation, the liver converts fat into ketone bodies, thus giving the name of this dietary treatment. The exact mechanism of action is unclear, but eventually frequency of epileptic seizures – in particular in children – is reduced. To be efficacious, ketogenic diet needs to be applied regularly, i.e. day by day. For this purpose, parents and – if suitable – children are taught by specialized diet assistants.

The parents of our young patient agreed on treatment with ketogenic diet and were introduced in preparing food on a ketogenic basis in the Epilepsy-Center Berlin-Brandenburg.

Some days after begin of ketogenic diet, the patient suffers from significantly less seizures. At an outpatient visit one month later, the mother reported one seizure per week. We agreed with the mother to continue this supplementary antiepileptic treatment as long as tolerated by her daughter.

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