What Is a CT Scan?

A computerized tomography scan (CT or CAT scan) uses computers and rotating X-ray machines to create cross-sectional images of the body. These images provide more detailed information than normal X-ray images. They can show the soft tissues, blood vessels, and bones in various parts of the body. A CT scan may be used to visualize the:

  • head
  • shoulders
  • spine
  • heart
  • abdomen
  • knee
  • chest

During a CT scan, you lie in a tunnel-like machine while the inside of the machine rotates and takes a series of X-rays from different angles. These pictures are then sent to a computer, where they’re combined to create images of slices, or cross-sections, of the body. They may also be combined to produce a 3-D image of a particular area of the body.

Why Is a CT Scan Performed?

A CT scan has many uses, but it’s particularly well-suited for diagnosing diseases and evaluating injuries. The imaging technique can help your doctor:

  • diagnose infections, muscle disorders, and bone fractures
  • pinpoint the location of masses and tumors (including cancer)
  • study the blood vessels and other internal structures
  • assess the extent of internal injuries and internal bleeding
  • guide procedures, such as surgeries and biopsies
  • monitor the effectiveness of treatments for certain medical conditions, including cancer and heart disease

The test is minimally invasive and can be conducted quickly.

How Is a CT Scan Performed?

Your doctor may give you a special dye called a contrast materialto help internal structures show up more clearly on the X-ray images. The contrast material blocks X-rays and appears white on the images, allowing it to highlight the intestines, blood vessels, or other structures in the area being examined. Depending on the part of your body that’s being inspected, you may need to drink a liquid containing the contrast. Alternatively, the contrast may need to be injected into your arm or administered through your rectum via an enema. If your doctor plans on using a contrast material, they may ask you to fast for four to six hours before your CT scan.

When it comes time to have the CT scan, you’ll be asked to change into a hospital gown and to remove any metal objects. Metal can interfere with the CT scan results. These items include jewelry, glasses, and dentures. Your doctor will then ask you to lie face up on a table that slides into the CT scanner. They’ll leave the exam room and go into the control room where they can see you and hear you. You’ll be able to communicate with them via an intercom.

While the table slowly moves you into the scanner, the X-ray machine will rotate around you. Each rotation produces numerous images of thin slices of your body. You may hear clicking, buzzing, and whirring noises during the scan. The table will move a few millimeters at a time until the exam is finished. The entire procedure may take anywhere from 20 minutes to one hour.

It’s very important to lie still while CT images are being taken because movement can result in blurry pictures. Your doctor may ask you to hold your breath for a short period during the test to prevent your chest from moving up and down. If a young child needs a CT scan, the doctor may recommend a sedative to keep the child from moving.

Once the CT scan is over, the images are sent to a radiologist for examination. A radiologist is a doctor who specializes in diagnosing and treating conditions using imaging techniques, such as CT scans and X-rays. Your doctor will follow-up with you to explain the results.

What Are the Risks Associated with a CT Scan?

There are very few risks associated with a CT scan. Though CT scans expose you to more radiation than typical X-rays, the risk of cancer caused by radiation is very small if you only have one scan. Your risk for cancer may increase over time if you have multiple X-rays or CT scans. The risk of cancer is increased in children receiving CT scans, especially to the chest and abdomen.

Some people have an allergic reaction to the contrast material. Most contrast material contains iodine, so if you’ve had an adverse reaction to iodine in the past, make sure to notify your doctor. Your doctor may give you allergy medication or steroids to counteract any potential side effects if you’re allergic to iodine but must be given contrast.

It’s also important to tell your doctor if you’re pregnant. Though the radiation from a CT scan is unlikely to harm your baby, your doctor may recommend another exam, such as an ultrasound or MRI scan, to minimize risk.

What Do CT Scan Results Mean?

CT scan results are considered normal if the radiologist didn’t see any tumors, blood clots, fractures, or other abnormalities in the images. If any abnormalities are detected during the CT scan, you may need further tests or treatments, depending on the type of abnormality found.

EEG (electroencephalogram)Test

Overview

An electroencephalogram (EEG) is a test that detects electrical activity in your brain using small, metal discs (electrodes) attached to your scalp. Your brain cells communicate via electrical impulses and are active all the time, even when you’re asleep. This activity shows up as wavy lines on an EEG recording.

An EEG is one of the main diagnostic tests for epilepsy. An EEG can also play a role in diagnosing other brain disorders.

Why it’s done

An EEG can determine changes in brain activity that might be useful in diagnosing brain disorders, especially epilepsy or another seizure disorder. An EEG might also be helpful for diagnosing or treating the following disorders:

  • Brain tumor
  • Brain damage from head injury
  • Brain dysfunction that can have a variety of causes (encephalopathy)
  • Inflammation of the brain (encephalitis)
  • Stroke
  • Sleep disorders

An EEG might also be used to confirm brain death in someone in a persistent coma. A continuous EEG is used to help find the right level of anesthesia for someone in a medically induced coma.

Risks

EEGs are safe and painless. Sometimes seizures are intentionally triggered in people with epilepsy during the test, but appropriate medical care is provided if needed.

How you prepare

Food and medications

  • Avoid anything with caffeine on the day of the test because it can affect the test results.
  • Take your usual medications unless instructed otherwise.

Other precautions

  • Wash your hair the night before or the day of the test, but don’t use conditioners, hair creams, sprays or styling gels. Hair products can make it harder for the sticky patches that hold the electrodes to adhere to your scalp.
  • If you’re supposed to sleep during your EEG test, your doctor might ask you to sleep less or avoid sleep the night before your test.

What you can expect

During the test

EEG electrodesEEG electrodesOpen pop-up dialog box

You’ll feel little or no discomfort during an EEG. The electrodes don’t transmit any sensations. They just record your brain waves.

Here are some things you can expect to happen during an EEG:

  • A technician measures your head and marks your scalp with a special pencil to indicate where to attach the electrodes. Those spots on your scalp might be scrubbed with a gritty cream to improve the quality of the recording.
  • A technician attaches discs (electrodes) to your scalp using a special adhesive. Sometimes, an elastic cap fitted with electrodes is used instead. The electrodes are connected with wires to an instrument that amplifies the brain waves and records them on computer equipment.Once the electrodes are in place, an EEG typically takes up to 60 minutes. Testing for certain conditions require you to sleep during the test. In that case, the test can be longer.
  • You relax in a comfortable position with your eyes closed during the test. At various times, the technician might ask you to open and close your eyes, perform a few simple calculations, read a paragraph, look at a picture, breathe deeply for a few minutes, or look at a flashing light.
  • Video is routinely recorded during the EEG. Your body motions are captured by a video camera while the EEG records your brain waves. This combined recording can help your doctor diagnose and treat your condition.

Ambulatory EEGs (aEEGs), which allow for longer monitoring outside an office or hospital setting, are in limited use. This test can record brain activity over several days, which increases the chances of catching seizure activity. However, compared to inpatient video-EEG monitoring, an ambulatory EEG is not as good at determining the difference between epileptic seizures and nonepileptic seizures.

After the test

The technician removes the electrodes or cap. If you had no sedative, you should feel no side effects after the procedure, and you can return to your normal routine.

If you used a sedative, it will take time for the medication to begin to wear off. Arrange to have someone drive you home. Once home, rest and don’t drive for the rest of the day.

Results

Doctors trained to analyze EEGs interpret the recording and send the results to the doctor who ordered the EEG. Your doctor might schedule an office appointment to discuss the results of the test.

If possible, bring along a family member or friend to the appointment to help you remember the information you’re given.

Write down questions to ask your doctor, such as:

  • Based on the results, what are my next steps?
  • What follow-up, if any, do I need?
  • Are there factors that might have affected the results of this test in some way?
  • Will I need to repeat the test?

Cannabis oil for epilepsy

On 1 November 2018, the Government’s landmark decision to reschedule some cannabis based products for medicinal use, came into force. The change in law means that specialist doctors in the UK can now prescribe medicinal cannabis to people with a limited number of conditions, including epilepsy. Here we explain what the change in law means for people with epilepsy.

What is cannabis?

Cannabis is made up of hundreds of different components. The most well known are two cannabinoids: CBD – cannabidiol – and THC – tetrahydrocannabinol. These are found naturally in the resin of the cannabis plant.

THC is the psychoactive compound in cannabis. It is responsible for the “high” people feel. The legal limit of THC content in a product, as stipulated by the Home Office, is 0.2%.

CBD is not psychoactive and it is thought to be responsible for many of the medical benefits associated with cannabis.

What is medicinal cannabis?

The Government has defined a cannabis-based product for medicinal use in humans as one that:

“Is or contains cannabis, cannabis resin, cannabinol or a cannabinol derivative; is produced for medicinal use in humans and is a medicinal product, or a substance or preparation for use as an ingredient of, or in the production of an ingredient of, a medicinal product”.

Guidance around prescribing cannabis-based products

In August 2019, NICE – the National Institute of Health and Clinical Excellence – announced that it would not be recommending that cannabidiol, a medicinal cannabis in the form of Epidyolex, should be prescribed on the NHS for children with two severe forms of epilepsy. This is on account of the fact that its long-term effect remains unclear.

The body also has concerns about the ‘viability of the economic model’ used by GW Pharma, the company that developed the drug, to establish the cost to be charged to the NHS for it. It concluded that Epidyolex would not, at this stage, be an effective use of NHS resources.

Our Medical Director, Professor Ley Sander, explains why he believes they are right to exercise caution.

The recommended guidelines are still only draft and the consultation closes on 16 September. So there is still time for you to have your say and let them know what you think. Professor Sander will be doing the same. All comments received will be considered by NICE and final guidance is likely to be published in November 2019.

The British Paediatric Neurology Association (BPNA) has drawn up interim guidance around epilepsy on behalf of NHS England.

The Association of British Neurologists (ABN) has also drawn up interim guidelines for the use of cannabis-based products in neurology for adults.

Guidance for other conditions is being drawn up the Royal College of Physicians with the Royal College of Radiologists (RCR) and the Faculty of Pain Medicine of the Royal College of Anaesthetists.

Guidance from the Association of British Neurologists (ABN)

Interim guidance from the ABN states that there is only published evidence for the use of medicial cannabis in Dravet syndrome and Lennox-Gastaut syndrome. Prescriptions should only be for cannabidiol.

Although the label Lennox-Gastaut is often broadly attached to severe epilepsies with compatible seizure types and intellectual disabilities, it is important that there is a clear syndromic diagnosis.

Dosing data for adults is currently very limited, although more information is expected shortly.

Guidance from the British Paediatric Neurology Association (BPNA)

The BPNA guidance states that non-licensed medicinal cannabis should only be considered for children who:

  • have an epilepsy that does not respond to conventional licensed anti-epileptic medications
  • have not responded to the ketogenic diet or who are not suitable for the ketogenic diet
  • who are not candidates for epilepsy surgery.

The BPNA states that the current best evidence for medicinal cannabis is CBD, a highly purified liquid, which has been licensed in the US by the Food and Drug Administration and is currently going through the application process for a licence from the European Medicines Agency.

CBD does not contain any significant amount of THC, the component of cannabis associated with producing a ‘high’.

What is the evidence?

The reason that the BPNA is only recommending CBD is that there is some evidence to show that this newly developed drug can be effective in reducing some type of seizures in Dravet and Lennox Gastaut syndromes.

Three double blind randomised controlled trials of pure CBD in children and young people with these syndromes has shown a greater reduction in monthly seizures compared to placebos. There was also a greater reduction in drop seizures in people taking CBD compared to those on a placebo.  Further open label studies have shown that it may also have an anti-epileptic effect in the epilepsies in general.

What is the evidence around THC?

While some studies have also suggested that THC may have an anti-epileptic effect, animal studies suggest it can also trigger seizures. There is no evidence from randomised controlled clinical trials for products with higher proportions of THC (more than 0.2 per cent).

Concerns have also been raised about the effect of THC on the developing brain in children and young people. Evidence suggests that chronic exposure to THC can affect brain development, structure and mental health.

There is also no good scientific evidence to support suggestions that the addition of THC in combination with CBD increases the efficacy of cannabis-based medicinal products for children.

“Clinicians should not feel under pressure to prescribe cannabis-based medicinal products until they have undergone proper clinical trials,” says the BPNA.

“We recommend that these products undergo randomised clinical trials for efficacy and safety before they are routinely prescribed in the UK. We welcome the rescheduling of these products from Schedule 1 to Schedule 2 that will enable their investigation in clinical trials.”

Children already on products containing THC

The BPNA also recommends that where children are already taking other cannabis-based products that contain higher proportions of THC, they should be transitioned on to CBD until strong evidence for these products can be produced through clinical trials.

The Government has no plans to legalise the use of cannabis for recreational purposes. Possession of cannabis is illegal. This includes cannabis for medical use unless it has been prescribed for you.

Getting a prescription for medicinal cannabis

Cannabis-based medicinal products can only be prescribed by a specialist. A GP cannot prescribe the medication but could refer you to a specialist.

The specialist will discuss all other treatment options with you first before considering a cannabis-based product.

A prescription for medicinal cannabis would only be given when all other treatment options have been tried or are considered unsuitable, and would only be given if the doctor considers it to be in your best interests.

People always have the option of seeking a second opinion.

Health food shops

There is also a wide range of other cannabis products available on the internet and in some commercial outlets such as health food outlets and from cannabis ‘dispensaries’ internationally. These products are of unknown quality and contain CBD and THC in varying quantities and proportions.

MHRA is working with individual companies to ensure that CBD-based products that make medicinal claims should be licensed and meet safety, quality and efficacy standards to protect public health. To date, the MHRA has licensed no other cannabis based medicinal products as medicines. 

Specialist epilepsy nurses

Specialist epilepsy nurses are trained nurses with extra qualifications in neurology, care of a patient with epilepsy and nurse prescribing.

We provide information and advice regarding epilepsy and its management. We can advise patients, their family or carers, other health professionals or other services such as employers about how to manage individual epilepsy needs. We also provide a point of contact between the Wessex Neurological Centre and GPs and other health professionals.

We hold five outpatient clinics a week to review patients after a first seizure, adolescents, vagal nerve stimulation and those with epilepsy that is difficult to control. We offer pre-conception counselling and support clinics. Patients can also access us via phone or email.

How the specialist epilepsy nurses can help 

Some of the issues we provide information or help with most often are

  • understanding and coping with the diagnosis of epilepsy
  • medication management and side effects
  • safety and first aid
  • issues for women (for example, pre-conception counselling, pregnancy)
  • epilepsy surgery
  • driving regulations
  • employment
  • social and leisure activities and travel
  • alcohol
  • national association contact details and local support groups.

Clinical assessment and monitoring

The specialist epilepsy nurses aim to assist patients with all aspects of living with epilepsy. They will discuss any information that has already been given, and review the management of epilepsy. They can also help patients manage side effects of medication and where necessary, adjust the dose. They will discuss the impact of the diagnosis and offer practical advice for managing this. They can also refer patients to other health professionals if necessary. Most importantly, they are here to listen to any questions and concerns.

Information resources

Information is given on an individual basis depending on the patient’s needs. We can discuss issues face to face, over the telephone or by e-mail. We have a large amount of written information on various subjects available for people to take from the outpatients clinic. We also have trained volunteers from the epilepsy information network run by the epilepsy society. 

The epilepsy nursing service also keeps a library of resources in various formats, such as leaflets, books, video tapes, audio cassettes and DVDs, on all aspects of living with epilepsy. These are available to borrow.

Education and training

The epilepsy nursing service is committed to improving and maintaining the standard of care for people with epilepsy.

We regularly run study days for patients and  where relevant, we provide support and training to employers and carers who work with people with epilepsy in the community. 

Voluntary organisations

We maintain strong links with the national associations and regularly teach at their national conferences. We also liaise with the local support groups in our region. Find out more about these in our sources of support.

What Is an EEG (Electroencephalogram)

An EEG, or electroencephalogram, is a test that records the electrical signals of the brain by using small metal discs (called electrodes) that are attached to your scalp. Your brain cells communicate with each other using electrical impulses. They’re always working, even if you’re asleep. That brain activity will show up on an EEG recording as wavy lines. It’s a snapshot in time of the electrical activity in your brain. 

EEG Uses

EEGs are used to diagnose conditions like:

  • Brain tumors
  • Brain damage from a head injury
  • Brain dysfunction from various causes (encephalopathy)
  • Inflammation of the brain (encephalitis)
  • Seizure disorders including epilepsy
  • Sleep disorders
  • Stroke

An EEG may also be used to determine if someone in a coma has died or to find the right level of anesthesia for someone in a coma.

EEG Risks

EEGs are safe. If you have a medical condition, talk with the doctor about it before your test.

If you have a seizure disorder, there’s a slight risk that the flashing lights and deep breathing of the EEG could bring on a seizure. This is rare. A medical team will be on hand to treat you immediately if this happens.

In other cases, a doctor may trigger a seizure during the test to get a reading. Medical staff will be on hand so the situation is closely monitored.

Preparing for an EEG

There are some things you should do to prepare for EEG:

  • Don’t eat or drink anything with caffeine for 8 hours before the test.
  • Your doctor may give you instructions on how much to sleep if you’re expected to sleep during the EEG.
  • Eat normally the night before and day of the procedure. Low blood sugar could mean abnormal results.
  • Let your doctor know about any medications — both prescription and over-the-counter — and supplements you’re taking.
  • Wash your hair the night before the test. Don’t use any leave-in conditioning or styling products afterward. If you are wearing extensions that use glue, they should be removed.

Vagus Nerve Stimulation

Someone recently asked me all about The Vagus Nerve Stimulation, well I got the answer for you right here.

Vagus nerve stimulation therapy is a treatment for epilepsy that involves a stimulator (or ‘pulse generator’) which is connected, inside the body, to the left vagus nerve in the neck. The stimulator sends regular, mild electrical stimulations through this nerve to help calm down the irregular electrical brain activity that leads to seizures.

There are several ways to treat epilepsy. How well each treatment works varies from one person to another. Vagus nerve stimulation therapy is a form of treatment for people with epilepsy whose seizures are not controlled with medication.

What are the vagus nerves?

The vagus nerves are a pair of nerves that start in the brain and run through the body. They carry messages between the brain and the body.

What is VNS therapy and how does it work?

Vagus nerve stimulation (VNS) therapy is a treatment for epilepsy that involves a stimulator (or ‘pulse generator’) which is connected, inside the body, to the left vagus nerve in the neck. The stimulator sends regular, mild electrical stimulations through this nerve to help calm down the irregular electrical brain activity that leads to seizures.

What is the aim of VNS therapy?

VNS therapy aims to reduce the number, length, and severity of seizures. For some people, their seizures become much less frequent, for some it may reduce their seizures a little, and for others it has no effect. VNS therapy may reduce the length or intensity of seizures but this does not happen for everyone. It may also reduce the time it takes to recover after a seizure. It is unlikely to completely stop seizures and it does not ‘cure’ epilepsy.

The effect of VNS therapy may not happen straightaway; it can take up to two years for it to have an effect on someone’s seizures. It is used alongside anti-epileptic drugs (AEDs) not instead of them. However, if VNS therapy works, it may be possible to reduce a person’s AEDs over time.

Can I be considered for VNS therapy?

VNS therapy is usually considered if you have tried a number of AEDs which have not fully controlled your seizures, and if you are not suitable for, or do not want to have, brain surgery.

People who are considering VNS will usually be given information about VNS from their neurologist or epilepsy specialist nurse.

What is the stimulator like?

The stimulator is a bit like a heart pacemaker. It is implanted (placed) under the skin in the upper chest (under the left collar bone) during a small operation under general anaesthetic.

Because of the size of the stimulator there will be a small lump where it lies, and a small scar where it was put in. A lead connects the stimulator in the chest to the vagus nerve in the left side of the neck. Because the electrodes are coiled around the nerve in the neck, there will also be a small scar where they are inserted, usually in the fold of the neck.

How does the stimulator work?

The stimulator is usually switched on within four weeks of it being implanted. The neurologist or nurse will programme the stimulator and set the amount (strength and length) of the electrical stimulation given. The amount of stimulation varies from person to person, but is usually started at a low level and slowly increased to a suitable level for each person. Usually it is set at 30 seconds of stimulation every five minutes through the day and night.

The stimulator has a battery inside it which can last up to ten years. When the battery is low, the stimulator needs to be replaced, during an operation similar to the one when it was put in.

What can VNS therapy do during a seizure?

Some people have a warning or aura which is a focal aware seizure that tells them that they are going to have a further seizure. When this happens, a special magnet can be passed over the stimulator to give stronger stimulation for a slightly longer period of time. This may stop the aura from developing into another seizure, or may reduce how long it takes the person to recover after a seizure.

Keep the magnet close by – it can be worn on the wrist like a watch, or on a belt, or attached to a wheelchair. For people who have no warning before a seizure, someone else could use the magnet for them when a seizure happens.

Some people may experience an increase in heart rate during their seizures. The AspireSR® and  SenTiva® devices can pick up these changes and give automatic stimulation in a similar way to magnet stimulation.

Does VNS therapy have any side effects?

VNS therapy can cause side effects but usually only during the time that the nerve is being stimulated. Side effects may not happen for everyone but can include discomfort in the throat, a cough, difficulty swallowing, and a hoarse voice.

Side effects may reduce over time and do not usually mean that the stimulator has to be switched off. If side effects are a problem, the neurologist or nurse can adjust the settings, or the magnet can be held over the stimulator for a few seconds to briefly stop the stimulation.

VNS therapy does not affect, and is not affected by, anti-epileptic drugs.

What about any other positive effects?

Some people feel that VNS therapy improves their mood, memory, or alertness, and may also help reduce depression or have a positive effect on their quality of life (overall wellbeing).

What happens if it does not work?

VNS therapy does not work for everyone. If there is no benefit received from VNS therapy, you and your specialist may consider having it switched off or removed. Even if VNS therapy has no effect on the seizures, it might have other positive effects (see previous question).

Can I have an MRI scan if I have VNS therapy?

If you have VNS therapy and need an MRI, it is important that everyone involved with the scan is aware so that they can decide if the scan can be done.

The MRI’s magnetic fields can cause the leads to overheat, which may cause burns to the skin near the electrodes or leads. Risks depend on the MRI machine used and the type of scan you need. It may be possible to scan the brain with an MRI scanner that has a very specific strength setting.

X-rays and CT scans do not affect, and are not affected by, VNS therapy. This is because they do not produce enough radiation to cause damage to the stimulator. However, extra care may be needed, or the stimulator may need to be switched off for the scan, and turned back on again afterwards.

Can I go through security at the airport?

At the airport, you can provide security officers with your VNS Therapy ID card, which explains that you have an implanted medical device. You can request a pat down check instead.

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.1

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.

The Ketogenic Diet and Epilepsy

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.1

ketogenic diet calorie distribution
Verywell / Emily Roberts

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.

Research suggests participant achieved better seizure control when on the KDE. A 2016 study agreed that this is the case for children under 2, but that the diets have similar outcomes for older children. It also noted that the modified Atkins diet has fewer serious side effects and better tolerability.10

Weird things can happen when you take a seizure

OK for those of you that don’t know me and my history of Epileptic seizures I am a 60yr old male who has suffered various types of seizures from 11/12yrs of age. Starting with Grand mals through to Complex/Simple partial seizres to dates

Because of the length of time I have had Epilepsy I quickly came to realise that I could do weird things during these seizures. Family or friends would say to me you did this, that or the next. The laughable thing was it was usually something daft or silly.

Anyhow last night was different from any other night as I usually spend a little time on the tablet before going to sleep.

Last night I took a Complex or focal seizure as it is now called my mobile & my glasses were on the bed before I took it, I remember climbing into bed ( this is where the weird bit comes in). It was at that point I never went on the tablet, instead I lay down and went to sleep.

My senses woke me around midnight (getting the feeling something wasn’t right), I turned onto my back to find my wife sitting up in bed in the dark, well that was me awake.

Eventually after being on the Tablet till about 2am I fell asleep again but oddly enough after all that I woke at 7.45am fresh as a daisy as they say

Chiarimalformation Seizures

In patients with Chiari malformation type 1 (CMI), epileptic seizures are occasionally reported both in symptomatic patients candidate to surgery and in patients without symptoms of tonsillar displacement in whom CM1 is often an incidental finding in the diagnostic work up for idiopathic epilepsies. In both groups of patients, the course of epilepsy is almost invariably favorable, with a few seizures easily controlled by treatment. In a subset of CM1 patients, epilepsy occurs in the context of neurodevelopmental disorders that also include mental retardation, autism and somatic dysmorphisms. Epileptic seizures must be accurately differentiated by potentially harmful paroxysmal events due to compression of the medulla, particularly by the cerebellar fits characterized by drop attacks, abnormal extensor posturing and apnea.