Video Presentations on Epilepsy and the Ketogenic Diet

"A Century of Progress: Ketogenic Diets for Epilepsy in Children and Adults" - Dr. Eric Kosoff

Dr. Kossoff received his medical degree from SUNY at Buffalo School of Medicine in New York. He went on to complete a residency in pediatrics at Eastern Virginia Medical School in Norfolk, Virginia. He completed a second residency in child neurology and a fellowship in pediatric epilepsy and clinical neurophysiology at The Johns Hopkins Hospital in Baltimore, Maryland.

He is a professor of neurology and pediatrics at Johns Hopkins Children's Center and focuses on the diagnosis and treatment of childhood seizures and epilepsy, particularly treatments other than medications, such as diet, neurostimulation, and surgery. Specific interests include the ketogenic diet, the modified Atkins diet for children and adults, infantile spasms, hemispherectomy, the interaction of migraine headaches with epilepsy, and Sturge-Weber syndrome.

Dr. Kossoff is also very involved in teaching and is the director of the Pediatric Neurology Residency Program. He is a coauthor of Treatment of Pediatric Neurologic Disorders and the 5th (and upcoming 6th) editions of Ketogenic Diets. He has been the editor of "Keto News" on since 2007 and is considered one of the world experts on dietary treatment for epilepsy.

Keto Diets for Epilepsy (Preview) - Dr. Eric Kosoff

How do you practically treat epilepsy with a keto diet? How did the low-carb high-fat way of eating become so mainstream among neurologists? And what can you do to prevent potential side effects?

Listen to this presentation by the neurologist Dr. Eric H. Kossoff from the recent Low Carb Breckenridge conference to hear the answers to these questions. 

Ketogenic Diets and Epilepsy - Dr. Eric Kosoff

Ketogenic diets have been used to treat seizures for 100 years. Dr. Eric Kossoff talks about the history of keto diets as well as the current status. We discuss how these concepts apply to kids and adults, and what else it can tell us about the safety and utility of ketosis.

Ketogenic Diet Therapy for Epilepsy - with Dr. Eric Kosoff

Dr. Eric Kossoff is one of the world's leading experts on ketogenic dietary therapy for neurological disorders. His research and clinical practice focus on the diagnosis and treatment of childhood seizures and epilepsy, and in 2003 he developed the Modified Atkins Diet for both kids and adults. Listen to the video to learn more about Dr. Kossoff's important work.

Ketogenic Diets and Seizure Management - Dr. Eric Kosoff

Filmed at the Emerging Science of Carbohydrate Restriction and Nutritional Ketosis, Scientific Sessions at The Ohio State University

An impressive body of scientific evidence over the last 15 years documents long term benefits of carbohydrate-restricted, especially ketogenic, diets. We now understand molecular mechanisms and why they work. Popular books and articles now challenge the advice ‘carbohydrates are good and fats are bad.’ Circa mid-19th century urinary ketones were identified in diabetics sealing their toxic label for the next 150 years. Despite work four decades ago showing ketones were highly functional metabolites, they are still misidentified as toxic byproducts of fat metabolism. The vilification of fat by regulatory and popular dogma perpetuates this myth. But the nutrition-metabolic landscape is improving dramatically.

A growing number of researchers have contributed to what is now a critical mass of science that provides compelling clinical evidence that ketogenic diets uniquely benefit weight loss, pre-diabetes, and type-2 diabetes. In the last five years, basic scientists have discovered that b-hydroxybutyrate (BHB), the primary circulating ketone, is a potent signaling molecule that decreases inflammation and oxidative stress. BHB has been suggested to be a longevity metabolite, with strong support from recently published mouse studies showing decreased midlife mortality and extended longevity and healthspan. Although type-2 diabetes is often described as a chronic progressive disease, emerging evidence indicates that sustained nutritional ketosis can reverses the disease. There is growing interest in studying potential therapeutic effects of ketosis on cardiovascular diseases, cancer, and neurodegenerative diseases including Alzheimer’s and Parkinson’s. There are even reasons certain athletes may benefit from nutritional ketosis and ketone supplements ─ debunking the long-standing dogma that high carbohydrate intake is required to perform optimally.

"Dietary Therapy for Epilepsy: Current Status and Future Directions" - with Dr. Eric Kosoff, MD

Dr. Eric Kossoff is a Professor of Neurology and Pediatrics at Johns Hopkins University in Baltimore, MD. He received his medical degree from SUNY at Buffalo School of Medicine in New York, followed by a residency in pediatrics at Eastern Virginia Medical School in Norfolk, Virginia. He completed a fellowship in child neurology and then pediatric epilepsy and clinical neurophysiology at The Johns Hopkins Hospital in Baltimore. He has been at Johns Hopkins since 1998. His research and clinical practice focuses on the diagnosis and treatment of childhood seizures and epilepsy, particularly treatments other than medications such as diet, neurostimulation and surgery. Currently the Medical Director of the Ketogenic Diet Center at Johns Hopkins, he is a world expert on the ketogenic diet and created the modified Atkins diet for children and adults in 2003. He is dedicated to bringing the use of diet therapies for neurologic disorders to the entire world and is the head of a Task Force within the International League Against Epilepsy to help achieve this goal. He is a coauthor of Ketogenic Diets: Treatments for Epilepsy and Other Disorders. Dr. Kossoff is also published in the fields of Sturge-Weber syndrome, the interaction between migraine and epilepsy in children, infantile spasms, Doose syndrome, and benign rolandic epilepsy. Dr. Kossoff is also very involved in teaching and mentorship and is the Director of the Pediatric Neurology Residency Program at Johns Hopkins.

The Potential of the Ketogenic Diet for the Treatment of Drug-Resistant Epilepsy in Children - Dr. Stefanie Prast-Nielsen, PhD

Stefanie Prast-Nielsen, PhD, Karolinska Institute, Solna, Sweden, discusses the history of the ketogenic diet, and comments on a study investigating the gut microbiota and serum inflammation profile using machine learning algorithms and omics integration analysis. The findings of the study indicate that children with drug-resistant epilepsy (DRE) who had an anti-seizure response to the ketogenic diet had a different gut microbiota composition to those who did not have an anti-seizure response. Specifically, Dr Prast-Nielsen comments on the abundance of Bifidobacteria and its correlation to tumor necrosis factor alpha (TNF alpha) levels present in the serum. This interview took place at the 14th European Epilepsy Congress (EEC) 2022 in Geneva, Switzerland.

Modified Ketogenic Diet for Epilepsy

Members of the Regional Epilepsy Service, within the department of neuropsychiatry, have developed a novel treatment intervention for adults with epilepsy that cannot be controlled with anti-epileptic drugs (AEDs). The modified ketogenic diet (MKD) service is the only NHS service in the UK offering this treatment for adults with poorly controlled epilepsy.

Between 30-40% of people with epilepsy will not respond to AEDs. The alternative options are limited to brain surgery or neurostimulation. Using the MKD offers a non-surgical treatment to minimise the risks associated with poorly controlled epilepsy including unexpected death in epilepsy, serious injuries and repeated hospital admissions.

The service offers an innovative, alternative treatment for refractory epilepsy that people are not able to access elsewhere in the UK. Service users undergo rigorous assessment and monitoring of their physical and mental health throughout the diet.

Monitoring Ketogenic Diets in Adults with Epilepsy - with Dr. Elizabeth Felton, MD, PhD

The assistant professor of neurology at the University of Wisconsin provided insight on the additional oversight required when caring for adult epilepsy patients who remain on the ketogenic diet.

"Ketone Effects on the Brain: ApoE4, Vascular Dementia, Ischemia and Epilepsy" - Dr. Dominic D'Agostino

Elevated levels of ketone bodies, such as beta-hydroxybutyrate, can have beneficial effects on several brain-related diseases. Research suggests that ketone bodies can increase blood flow in the brain by 30 to 40 percent, which may have profound effects for patients with brain injury or vascular dementia. By studying ischemic wounds, which are analogous to an aged brain or clogged arteries, researchers observed increased blood flow when ketone levels were elevated. Nutritional ketosis may also reduce neural inflammation which may be a predictor of seizure in epilepsy. In this clip, Dr. Dominic D'Agostino describes the positive effects that ketones can have on the brain.

Scholarly Articles on Epilepsy and the Ketogenic Diet

Ketogenic Diet and EpilepsyCurrently available pharmacological treatment of epilepsy has limited effectiveness. In epileptic patients, pharmacological treatment with available anticonvulsants leads to seizure control in <70% of cases. Surgical intervention can lead to control in a selected subset of patients, but still leaves a significant number of patients with uncontrolled seizures. Therefore, in drug-resistant epilepsy, the ketogenic diet proves to be useful. The purpose of this review was to provide a comprehensive overview of what was published about the benefits of ketogenic diet treatment in patients with epilepsy. Clinical data on the benefits of ketogenic diet treatment in terms of clinical symptoms and adverse reactions in patients with epilepsy have been reviewed. Variables that could have influenced the interpretation of the data were also discussed (e.g., gut microbiota). The data in this review contributes to a better understanding of the potential benefits of a ketogenic diet in the treatment of epilepsy and informs scientists, clinicians, and patients—as well as their families and caregivers—about the possibilities of such treatment. Since 1990, the number of publications on attempts to treat drug-resistant epilepsy with a ketogenic diet has grown so rapidly that it has become a challenge to see the overall trajectory and major milestones achieved in this field. In this review, we hope to provide the latest data from randomized clinical trials, practice guidelines, and new research areas over the past 2 years.
Effectiveness, retention, and safety of modified ketogenic diet in adults with epilepsy at a tertiary-care centre in the UK - Journal of NeurologyWith the rising demand for ketogenic diet therapy in adult epilepsy, there is a need for research describing the real-life effectiveness, retention, and safety of relevant services. In this 1-year prospective cohort study we present outcomes of the first 100 referrals for modified ketogenic diet (MKD) at the UK’s largest tertiary-care epilepsy centre, where patients received dietetic review up to twice per week. Of the first 100 referrals, 42 (31 females, 11 males; mean age 36.8 [SD ± 11.4 years]) commenced MKD, having used a mean of 4 (SD ± 3) previous antiepileptic drugs. Retention rates were: 60% at 3 months, 43% at 6 months, and 29% at 12 months. 60% of patients reported an improvement in seizure frequency, 38% reported a > 50% reduction, and 13% reported a period of seizure freedom; 30% reported a worsening in seizure frequency at some point during MKD therapy. The most common reasons for discontinuing MKD were side effects and diet restrictiveness. The most common side effects were weight loss, gastrointestinal symptoms and low mood. The likelihood of discontinuing MKD was significantly decreased by experiencing an improvement in seizure frequency (p ≤ 0.001). This study demonstrates that MKD can be effective in adults, although, even with regular dietetic support, retention rates remain low, and periods of worsening seizure frequency are common.
The Efficacy of Ketogenic Diet in 60 Chinese Patients With Dravet SyndromeObjective: To evaluate the efficacy and safety of ketogenic diet (KD) in patients with Dravet syndrome (DS).Methods: 60 DS patients receiving treatment of KD for more than 12 weeks from 2009 to 2018 were analyzed retrospectively. Modified Johns Hopkins protocol was used to initiate KD. Seizure frequency, electroencephalogram (EEG), cognition, language, and motor function of the patients were assessed. Side effects were monitored and adjusted accordingly. SPSS 23.0 software was used for all statistical analysis.Results: In total, 60 DS patients (34 boys, 26 girls) received treatment of KD for more than 12 weeks, and among them 41 (68.3%) patients remained on the diet for more than 24 weeks, 22 (36.7%) patients for more than 48 weeks. Seizures in 35 patients (58.3%) were reduced by over 50% at 12 weeks, and the KD effect was observed within 2 weeks in most of them. At 24 weeks, 61.1% (25/41) of the patients had a >50% seizure reduction. At 48 weeks, 77.3% (17/22) had an over 50% reduction in their seizure frequency. With the treatment of KD in the 60 DS patients, 10 patients had ever been seizure free for 12 months to 24 months (The median duration was 20 months). In 10 KD-effective patients, the background rhythm of their EEG showed obvious improvement, and interictal epileptic discharges decreased significantly. Cognitive function of 22 patients was improved. Language progressed in 14 patients. Motor function was improved in 13 patients. The efficacy of KD in DS patients d...

Other Resources on Epilepsy and the Ketogenic Diet

First Do No Harm - TV Movie (1997)

First Do No Harm is a 1997 American made-for-television drama film directed by Jim Abrahams about a boy whose severe epilepsy, unresponsive to medications with terrible side effects, is controlled by the ketogenic diet. Aspect of the story mirror Abrahams' own experience with his ver own son Charlie who had epilepsy.

The director and producer, Jim Abrahams, was inspired to make the film as a result of his own experiences with his son Charlie. Charlie developed a very serious seizure condition that proved intractable despite several medications and surgery. His cognitive decline was described by Abrahams as "a fate worse than death". He came across the diet in a book on childhood epilepsy by John Freeman, director of the Pediatric Epilepsy Center at Johns Hopkins Hospital. Charlie was started on the diet and rapidly became seizure-free. In addition, medications were tapered and his mental development restored. Abrahams was outraged that nobody had informed him of the diet. He created the Charlie Foundation to promote the diet and funded research studies to demonstrate its effectiveness.

Although the film plot has parallels with the Abrahams' story, the character of Robbie is a composite one and the family circumstances are fictional. Several minor characters in the film are played by people who have been on the ketogenic diet and had their epilepsy "cured" as a result. The dietitian Millicent Kelly plays herself. Charlie Abrahams appears as a young boy playing with Robbie in the hospital, whose mother quickly removes him when she discovers Robbie has epilepsy—as though it were an infectious disease.