Brain Cancer and Brain Tumours

Understanding the brain

The main parts of the brain include:

The cerebrum. This is divided into the right side (right hemisphere) which controls the left side of the body, and the left hemisphere which controls the right side of the body. Each hemisphere is divided into various subsections, the main divisions being the frontal lobe, temporal lobe, parietal lobe and occipital lobe. The cerebrum is also where you think and store your memory.

The cerebellum. This lies behind and below the cerebrum. One of its main functions is to help control balance and co-ordination.

The brain stem. This helps to control basic bodily functions such as the heartbeat, breathing and blood pressure. Nerves from the cerebrum also pass through the brainstem to the spinal cord.

The meninges. These are thin layers of tissue which separate the skull from the brain. The outer layer next to the skull is called the dura. The next layer is called the arachnoid. Under the arachnoid tissue is the cerebrospinal fluid (CSF) which bathes the brain and spinal cord.

The pituitary gland. This releases various hormones into the bloodstream.

The main type of cell in the brain is called a neuron. There are millions of neurons in the brain. Neurons have long thin nerve fibres which enable them to send messages to other parts of the brain and down the spinal cord to all parts of the body. The brain also contains glial cells. These provide support, nourishment and protection for neurons. There are various types of glial cells, including astrocytes, oligodendrocytes and ependymal cells.

The original site where a tumour first develops is called a primary tumour. Cancerous (malignant) tumours may also spread to other parts of the body to form secondary tumours (metastases). These secondary tumours may then grow, invade and damage nearby tissues and spread again.

Primary malignant brain tumours

A primary malignant brain tumour is a cancer which arises from a cell within the brain. The cells of the tumour grow into and damage normal brain tissue. Also, like non-cancerous (benign) brain tumours, they can increase the pressure inside the skull. However, unlike most other types of malignant tumours, primary brain tumours rarely spread (metastasise) to other parts of the body.

There are various types of primary malignant brain tumour. The different types develop from different types of cell in the brain. As a general guide, each type is graded on a scale of 1-4. Grade 1 and grade 2 tumours are said to be low-grade; grade 3 and grade 4 are termed high-grade. The higher the grade, the more aggressive the tumour tends to be and the faster it tends to grow. The treatment options and outlook (prognosis) can vary depending on the type and grade of the tumour.

Secondary malignant brain tumours

A secondary malignant brain tumour means that a cancer which started in another part of the body has spread to the brain. Many types of cancer can spread to the brain. The most common types that do this are cancers of the breastlungbowelkidney and skin (melanoma).

See the separate leaflet called Cancer for more general information about cancer

There are many types of non-cancerous (benign) brain tumours and primary cancerous (malignant) brain tumours. Many are very rare. The following is a brief description of the most common types.

Meningioma

Meningiomas are usually benign. They grow from cells in the tissues that surround the brain (the meninges).

Medulloblastoma

These are high-grade malignant tumours that grow in the cerebellum. They are uncommon in adults but are one of the two most common brain tumours in children. The other is astrocytoma in the cerebellum.

Gliomas

These are malignant primary brain tumours that arise from glial cells. There are various types, depending on the cell of origin – for example:

  • Astrocytomas (originating from astrocyte cells.) There are various types of astrocytoma. They include:
    • Low-grade astrocytomas.
    • Anaplastic astrocytoma. This is a high-grade tumour.
    • Glioblastoma multiforme. This is a high-grade tumour which tends to grow quite quickly. It is the most common type of primary malignant brain tumour in adults.
  • Oligodendrogliomas (originating from oligodendrocytes). These can vary in their grade.
  • Ependymoma (originating from ependymal cells). These are rare but are usually low-grade.

Primitive neuroectodermal tumours (PNETs)

These are very similar to medulloblastomas and mainly occur in children.

Pituitary tumours

There are various types of tumour which arise from the different cells in the pituitary gland. They tend to be benign. However, the cells of the tumour may produce large quantities of hormones which can cause various symptoms. As they grow, they may also cause pressure symptoms. The nerves of sight (optic nerves) are near to the pituitary gland and so a growing pituitary gland tumour may press on an optic nerve and affect vision.

Acoustic neuroma

An acoustic neuroma (schwannoma) is a benign tumour which arises from Schwann cells which cover the nerve that goes to the ear. Symptoms can include deafness on the affected side and dizziness with a spinning sensation (vertigo).

Other

There are various other rare types of benign and primary malignant brain tumours.

The cause of most non-cancerous (benign) brain tumours and primary cancerous (malignant) brain tumours is not known.

Genetic factors may be a risk for some people – perhaps in about 1 in 20 cases. For example, people with the hereditary diseases called neurofibromatosis type 1, Turcot’s syndrome, Li-Fraumeni cancer syndrome, and tuberous sclerosis have a higher-than-average risk of developing a glioma. When people with these diseases develop a glioma, it tends to occur in childhood or early adult life. However, these cases are only a small proportion of all glioma tumours.

Note:

  • Most gliomas occur in older adults and inherited (genetic) factors are not thought to be involved.
  • Previous radiotherapy to the brain is thought to increase the risk of a brain tumour.
  • There is no strong evidence that using mobile phones increases the risk of brain tumours.
  • Secondary (metastatic) brain tumours arise from various cancers of the body. These have various causes. See the separate leaflets about these other cancers.

Non-cancerous (benign) brain tumours and cancerous (malignant) primary brain tumours are uncommon. Overall they occur in about 12 in 100,000 people each year.

The most common types in adults are benign meningioma and a glioma called glioblastoma multiforme. Some types are very rare.

Brain tumours can occur at any age. Some types (such as medulloblastoma) are more common in children and some are more common in adults. Generally, the tumours that tend to occur in adults become more common with increasing age.

Secondary (metastatic) brain tumours are more common than benign brain tumours and malignant primary brain tumours.

General symptoms

Early symptoms may include headaches and feeling sick. These are due to increased pressure within the skull (raised intracranial pressure). These symptoms may come and go at first and tend to be worse in the morning. Coughing, sneezing and stooping may make the headaches worse. Epileptic seizures (convulsions) sometimes occur. Increasing drowsiness may occur as the tumour enlarges.

Note: most people who have headaches or epilepsy do not have a brain tumour.

Symptoms due to the location in the brain

As a tumour grows it can damage the nearby brain tissue. The functions of the different parts of the body are controlled by different parts of the brain. Therefore, the symptoms vary from case to case, depending on which part of the brain is affected and on the size of the affected area. For example, one or more of the following may develop:

These symptoms tend to develop gradually.

A doctor will examine you if a brain tumour is suspected from the symptoms. This will include checking on the functions of the brain and nerves (movements, reflexes, vision, etc).

A magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan of the head is the common test done to confirm or rule out the presence of a brain tumour. See the separate leaflets called MRI Scan and CT Scan for more details. If a tumour is identified, further more detailed scans and tests may be done. For example, a PET scan or a cerebral angiogram are sometimes done to obtain more information about the tumour.

small tissue sample (a biopsy) may be needed to be sure of the type of tumour. The sample is then examined under the microscope to look for abnormal cells. To obtain a biopsy from a brain tumour you need to have a small operation, usually done under anaesthetic. A small hole is bored in the skull to allow a fine needle through to obtain a small sample of tissue. By examining the cells obtained by the biopsy, the exact type of tumour can be identified. If it is cancerous (malignant), the tumour grade can be determined (see above).

Blood tests and other tests on other parts of the body may be done if the tumour is thought to be a secondary (metastatic) tumour. For example, it is quite common for a lung cancer to spread to the brain. Therefore, a chest X-ray may be done if this is suspected. Various hormone tests may be done if a pituitary gland tumour is suspected. 

The main treatments used for brain tumours are surgery, chemotherapy, radiotherapy and medication to control symptoms such as seizures. The treatment or combination of treatments advised in each case depends on various factors – for example:

  • The type of brain tumour.
  • The grade of the tumour if it is cancerous (malignant).
  • The exact site of the tumour.
  • Your general health.

Surgery

Surgery is often the main treatment for non-cancerous (benign) brain tumours and primary cancerous (malignant) tumours. The aim of surgery is to remove the tumour (or even some of the tumour) whilst doing as little damage as possible to the normal brain tissue. Your specialist will advise on whether surgery is a possible option.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops cancer cells from multiplying. See the separate leaflet called Radiotherapy for more details.

Radiotherapy is sometimes used instead of surgery when an operation is not possible for a malignant brain tumour. Sometimes it is used in addition to surgery if it is not possible to remove all the tumour with surgery or to kill cancerous cells which may be left behind following surgery.

Chemotherapy

Chemotherapy is a treatment which uses anti-cancer medicines to kill cancer cells, or to stop them from multiplying. See the separate leaflet called Chemotherapy for more details. It may be used in addition to other treatments such as surgery or radiotherapy; again, depending on various factors such as the type of tumour.

Medication to control symptoms

If you have seizures caused by the tumour then anticonvulsant medication will usually control the seizures. Painkillers may be needed to ease any headaches. Steroid medication is also commonly used to reduce inflammation around a brain tumour. This reduces the pressure inside the skull, which helps to ease headaches and other pressure symptoms.

You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects and other details about the possible treatment options for your type of brain tumour.

You should also discuss with your specialist the aims of treatment. For example:

  • In some cases, treatment aims for a cure. If a benign tumour can be removed by surgery then a cure is likely. The chance of a cure for malignant tumours varies, depending on the type of tumour, grade and other factors such as the location in the brain. Note: when dealing with malignant tumours, doctors tend to use the word remission rather than the word cured. Remission means there is no evidence of cancer following treatment. If you are in remission, you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.
  • In some cases, treatment aims to control the cancer. If a cure is not realistic, with treatment it may be possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
  • In some cases, treatment aims to ease symptoms (palliative treatment). For example, if a cancer is advanced then you may require painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer, which may ease symptoms such as pain.

It is difficult to give an overall outlook (prognosis). Every case is different. For example, if you have a non-cancerous (benign) meningioma which is in a suitable place for surgery, the outlook is excellent.

For primary cancerous (malignant) brain tumours, the outlook will vary, depending on the type, grade and location in the brain.

The outlook is often poor if you have a secondary (metastatic) malignant brain tumour.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook and how well your type and stage of cancer is likely to respond to treatment. 

Epilepsy in Pets

What is Epilepsy?

Seizures are the physical manifestation of uncontrolled electrical activity in the brain and are the most common neurological problem in canines and felines. They can be very distressing and cause anxiety for you and your pet. All of the cells in the brain communicate with each other using chemical and electrical signals. Seizures are the physical manifestation of uncontrolled and hyper-synchronous electrical activity in the brain.

How can I tell if my dog has Epilepsy?

Different types of seizure can occur in animals; most typically ‘generalised’ seizures are seen. Generalised seizures cause a loss of consciousness, involuntary repetitive movements, urination, salivation and defecation. Smaller or ‘partial’ seizures involve more focal areas of the brain and may appear as muscle spasms/tremors, abnormal sensations or even hallucinations. Your pet may exhibit any variation of the aforementioned signs however be rest assured that your pet does not feel pain during a seizure and are largely unaware they are occurring. However they may feel disorientated and confused afterwards for a variable time period. It is important to give them reassurance and the opportunity to adjust following a seizure. Usually this involves some TLC and rest.

What is the cause of Epilepsy?

Seizures may occur due to an identifiable cause; like intoxication, kidney disease, liver disease, brain malformations, tumours or inflammation (so called ‘symptomatic’ epilepsy). When an underlying cause cannot be identified, primary or idiopathic epilepsy is the presumed diagnosis. In most cases we assume this is related to an underlying genetic predisposition, but multiple genes and environmental factors are involved in developing epilepsy.

How is Epilepsy diagnosed?

No single test can tell if your pet has primary epilepsy. It is what we call a ‘diagnosis of exclusion’ as multiple tests are required to exclude all other causes of seizures. Typically, a diagnostic investigation is split into two parts; firstly to investigate and exclude diseases where the seizures are caused by a problem outside of the brain, secondly to investigate and exclude those within the brain itself. Your pet will most likely have a blood sample taken and a urine sample as part of the diagnosis process. Finances permitting, advanced brain imaging via magnetic resonance imaging (MRI) of the brain may also be performed by our advanced diagnostic imaging team followed by cerebrospinal fluid analysis to exclude structural abnormalities (such as inflammation, or tumours) as a cause of clinical signs. Primary epilepsy is most likely in young animals (1-6 years of age) that are neurologically normal (normal behaviour, normal gait, etc) between the seizures.

MRI scan of a normal brain

Primary epilepsy most likely has a complex genetic and environmental cause. It is rare that vets and scientists have been able to identify the genes responsible in individual animals or dog breeds; however, several dog breeds are known to have a higher ‘familial’ risk of epilepsy, the same may be true for cats. Most epilepsies are ‘poly-genic’, involving mutations in lots of genes. This means that unlike recessively inherited genetic diseases, breeding to prevent epilepsy is very difficult and primary epilepsy can be diagnosed in any individual animal of any breed despite multiple normal generations and litters.

How is Epilepsy treated?

It is possible for most epileptic animals to have an excellent quality of life. However, epilepsy is a chronic and occasionally progressive disease that will need to be managed. Rarely, an animal may have a single seizure and not seizure again. An animal that has more than one seizure is expected to have more frequent or severe seizures in the future. There is evidence to suggest that early treatment in the course of the epilepsy can provide a better long-term outcome.

Despite treatment, epileptics are still likely to suffer intermittent seizures. Full remission may occur with treatment, but our goal in the majority of patients is to reduce the frequency of seizures by at least 50% within a four week period. The severity of seizures should also reduce. 25-33% of dogs with epilepsy will require more than one medication in order to control their seizures. The same may be true for cats. We normally recommend epilepsy is treated when more than two seizures occur in a six month period.

There are many different anti-epileptic drugs (AEDs) available for the treatment of epilepsy. Your neurology clinician or primary care vet will determine which AED is suitable based on the type and number of seizures your pet has had, but also on licensing, formulation, and cost considerations. Two drugs are licensed for the treatment of primary epilepsy in dogs; Phenobarbital (commonly prescribed under the trade name EpiphenTM) and Imepitoin (prescribed under the trade name PexionTM). Potassium bromide (prescribed under the trade name LibromideTM) is licensed for uncontrolled epilepsy in dogs. No medication is licensed for cats but we have lots of experience of treating cats with phenobarbital.

We have experience with many other AEDs that are only licensed in people but used in animals. These medications are only used in special circumstances are not recommended in the first-line treatment of epilepsy in animals. The main reason for this is that dogs metabolise these medications very quickly and they are less effective in dogs than they are in people.

With most AEDs side effects of treatment can be expected to occur. These side effects are typically worse in the first few weeks of treatment and their severity may decrease with time. Common dose-dependent side effects include increased thirst and hunger (consequently urination and weight gain), lethargy, panting, hyper-excitability and possibly wobbliness. Your neurology clinician or primary care vet will discuss with you what side effects may be expected with medication.

What can you do to help your Epileptic pet?

It is very important to keep a seizure diary for your pet. The diary should include the date, the number of, the duration and appearance and severity of the seizure(s), whether there was any obvious precipitating cause, whether abnormal behaviour was seen in the period after a seizure (post-ictal period). Sharing these diaries with your neurology clinician or primary care vet will assist them in assessing whether treatment is reaching its goals. In addition, it will help to de-emotionalise the seizure experience if you and your family understand what should be done when they occur.

During a seizure you should do the following things to protect your pet:

  • Move any objects from around your pet that they may injure themselves on e.g. furniture
  • Turn off the lights, music and television to reduce environmental stimulation
  • Begin monitoring and recording their duration and severity of the seizure

Never be tempted to put your hands in or around your pet’s mouth. Animals may bite during or after a seizure as they may not recognise you. It is understandable that you will want to comfort your pet but only hold them if they have stopped actively seizing and if they are seeking attention. If your neurology clinician or primary care vet has prescribed rectal diazepam this can be administered as instructed if it is safe to do so.

Contact your vet as soon as possible if:

  • Your pet is actively seizing for more than two minutes
  • Your pet has more than two seizures in a 24-hour period
  • Your pet is showing recurrent twitching / tremoring

What is the prognosis of Epilepsy?

The prognosis for epilepsy is typically good although it is largely dependent on the number of seizures an animal suffers.

Occasional visits to your primary care vet may be required during the course of treatment. Some AEDs will be metabolised by the liver. This metabolism can increase with time, meaning higher drug dosages may be required to maintain the same concentration of the drug in the blood. Your vet may suggest blood tests every few months to assess the concentration of the AED in the blood, or to assess the function of the liver. How often this is required will be dependent on your pet’s response to treatment.

My Epilepsy Drugs#1

Sodium Valproate Chrono 300MG

Epilim Chrono is basically Sodium valproate. This medicine comes in 500 mg, 300 mg and 200 mg. Its is widely used mood stabilizer. Epilim Chrono contains Sodium valproate which stabilizes electrical activity in human brain. Epilim Chrono is used to treat:

  • Epilepsy 
  • Panic attack
  • Anxiety disorder 
  • Posttraumatic Stress Disorder

Epilim Chrono should not be used by women during pregnancy as it can cause birth defects.

Epilim Chrono Weight Gain Tablets

Epilim Chrono tablet’s major side effect is weight gain. That why some people try to use it as a weight gain tablet. betterhealthfacts.com strongly suggest you to use these tablets only after consulting a doctor.

Epilim Chrono Side Effects

Epilim Chrono is known for its side effects from past few years. Some of its common side effects are
Tiredness
Sedation
Gastrointestinal Disturbances
Tremor
Reversible Hair Loss

Ketogenic Diet for Epilepsy

The ketogenic diet for epilepsy (KDE) is a special diet that has helped many children and some adults achieve better (or even full) control of their seizures. It’s a first-line treatment for a few specific epilepsy syndromes, such as epilepsy due to mutations in GLUT-1 or pyruvate dehydrogenase deficiency.

Background

The ketogenic diet for epilepsy was developed in the 1920s by a Michigan doctor named Hugh Conklin. However, once effective medications were developed, the diet was used less and less frequently.2

It has regained recognition and has become a standard backup plan for children whose epilepsy symptoms are difficult to control with medication.1 With more than 470,000 children living with seizure disorders in the United States (according to Centers for Disease Control and Prevention statistics), it’s an important addition to the arsenal of treatments for epilepsy.

Researchers are also beginning to see how it might help adults with epilepsy and people with a variety of neurologic disorders.

What It Entails

The ketogenic diet for epilepsy is a very high-fat diet with just enough protein for body maintenance and growth, and very low amounts of carbohydrate.

When fats are broken down for energy, the body goes into what’s called a ketogenic state, in which the body generates molecules called ketones. The goal of the KDE is for the brain to use ketones for energy rather than glucose (sugar) as much as possible.

Ketones are (largely) water-soluble, so they are easily transported to the brain. The brain cannot use fatty acids for energy, but it can use ketones for a large portion of its energy requirements.1

The KDE is usually begun in a hospital setting and often begins with a one- to two-day fasting period, though there may be a trend away from both of these requirements.3

After determining the proper amount of protein (depending on age, etc.), the diet is structured as a ratio of fat grams to protein grams, plus carb grams. It usually begins with a 4 to 1 ratio and can be fine-tuned from there. The diet is often calorie and fluid-limited.4 Additionally, no packaged low-carb foods (shakes, bars, etc.) are allowed for at least the first month.

Because a gram of fat has more than twice the calories of a gram of protein or carbohydrate, this equation means that at least 75% of the calories in the diet come from fat. This is a very strict diet, and it takes time to learn how to put together meals that fit the formula. All food must be weighed and recorded.

Weaning off the diet is often attempted after two years, though some children are kept on it for longer.

Why It Works

Researchers are beginning to understand why the ketogenic diet works to lower seizure frequency. According to a 2017 review of studies, it appears that several mechanisms may be at work, including the following.

  • The diet appears to alter ketone metabolism in the brain in a way that enhances the brain’s ability to produce the neurotransmitter GABA, which has a calming effect on the brain.1
  • The diet has significant anti-inflammatory and anti-oxidative impacts, which appear to alter the way some genes involved in epilepsy are expressed.
  • Certain fatty acids featured in the diet have anticonvulsant effects and have even been shown to boost the effects of valproic acid—a common anti-seizure medication.
  • Polyunsaturated fatty acids in the diet may prevent brain cells from becoming overexcited.
  • Decanoic acid, which is part of the diet as well, appears to have a direct inhibitory reaction on the AMPA receptors in the brain. These receptors are believed to play a role in epilepsy and are the target of some epilepsy medications.
  • Effects on a key sensor of cellular energy appear to help prevent excessive firing of brain cells.
  • The diet may impact circadian activities and the expression of a growth factor in the brain in a beneficial way.5

Effectiveness

Studies generally show that about a third of children with epilepsy who follow the ketogenic diet will have at least a 90% reduction in seizures, and another third will experience a reduction of between 50% and 90%.46

This is remarkable, considering that these patients are generally those whose seizures are not well-controlled with medications.

In Adults

A growing number of studies have been done on the KDE and modified Atkins Diet in adults with seizure disorders, and the results are similar to studies with children.

One 2014 study reported that 45% of adolescent and adult participants saw a reduction of seizure frequency of 50% or greater. Tolerability appeared better in those with symptomatic generalized epilepsy.

Interestingly, it was more difficult to keep adults on the diet, since they obviously have more control over what they eat. Research is still limited in this area and more trials are needed.7

In Pregnancy

A 2017 report on use of these diets during pregnancy suggests they may be an effective way to control seizures and could possibly allow pregnant women to use lower doses of epilepsy medication. However, the safety of this still needs to be examined.8

Work With Your Medical Team

It is vital that anyone using this diet for a seizure disorder do it under the supervision of an experienced physician and dietitian. Many individual variations can influence the exact diet recommendations for each person, and coordinating this eating plan with medications can be tricky. It’s not something you should ever attempt on your own.

A Typical Day’s Menu

Below is a shortened description of a menu appearing in the 2015 Pediatric Annals article, “The Ketogenic Diet: A Practical Guide for Pediatricians.” It’s meant to give the idea of what children eat on the diet, not serve as an exact prescription. Remember, all of these foods are carefully weighed and measured.

  • Breakfast: Eggs made with heavy cream, cheese, and butter; small serving of strawberries, pineapple, or cantaloupe
  • Lunch: Hamburger patty topped with cheese; cooked broccoli, green beans, or carrots with melted butter; whipped heavy cream
  • Dinner: Grilled chicken breast with cheese and mayonnaise; cooked vegetables with butter; whipped heavy cream
  • Snacks: Whipped heavy cream, small servings of fruit, sugar-free gelatin

Variations substitute coconut oil or MCT oil for some of the heavy cream and butter.

Eating While at School

With a school-aged child, keeping them on the diet during the school day is difficult but essential. Thinking and planning ahead can help you be successful. You may want to try some of the following strategies:

  • Talk to your child: Make sure your child understands the diet and why sticking to it is essential. Let them know they shouldn’t trade food with other kids. As hard as it is, they also shouldn’t eat food from vending machines or treats handed out in class.
  • Talk to the school: The teacher, guidance counselor, nurse, and administration all need to be aware of your child’s special dietary needs (as well as other health-related matters). You’ll want to have regular conversations with them, and you may want to have a 504 plan or individualized education plan (IEP) in place as well.
  • Become a planner: Gather several recipes for appropriate meals that can make convenient, easy-to-pack lunches. If possible, you may want to provide appropriate treats for your child for holiday parties and other special events that you may know about ahead of time. The Charlie Foundation and Clara’s Menu are good resources for child-friendly keto recipes.
  • Educate family members: It’s important that family members and any regular caregivers know how to prepare a meal for the child with epilepsy.
  • Establish routines: The timing of meals and snacks needs to be consistent in order for your child’s glucose levels to remain as stable as possible. You may need to work with your child’s teacher(s) on this.
  • Involve a friend: Having a friend at school who understands the importance of your child’s diet may help them feel less awkward about being “different” and give them someone to lean on for support when needed. Make sure your child is OK with this and give them input on which friend to choose.

You’ll also want to make parents of your child’s friends aware of the special diet and that what some people may consider “a little harmless cheating” may not be harmless at all. It’s a good idea to provide food for your child to take to parties and playdates.How to Raise Kids Who Are on a Special Diet

Alternatives to the Super-Strict Ketogenic Diet

The Modified Atkins Diet is a popular alternative that helps many who find the ketogenic diet too difficult to adhere to. This diet is far less restrictive, as calories, fluids, and protein are not measured.9

The diet begins with 10 grams of carbohydrate per day for the first month, which slowly increases to 15 or 20 grams. It is similar to the very strict induction phase of the standard Atkins diet.

One 2014 study reported that 45% of adolescent and adult participants saw a reduction of seizure frequency of 50% or greater. Tolerability appeared better in those with symptomatic generalized epilepsy.