A low fat diet is good for people who have eaten lots of meat and cheese and fat during their lies; it will help them re-balance and return to a more healthful equilibrium. On the other hand, a low fat diet is bad for people who have been eating raw food, fruit and vegetables for most of their lives. A high fat diet is also good for people with neurological disorders, particularly seizures. Seizures are not uncommon among young children, especially those who have been vaccinated (see WDDTY vol 6 no 8.)

Seizure disorder, or epilepsy, is an abnormality of the electric potentials, or waves, produced in the normal brain. We fluctate between the normal 9-14 alpha waves per second of the waking state, and the 3-6 per second delta waves of the sleeping state. In epilepsy, these waves go out of step, and an electro encephalograph will indicate abnormal firings of the brain’s neurons.

Related neurological disorders include severe headaches, absence seizures or staring episodes, dizzy spells or impaired memory.

It is a fact little known by the general public that dietary modification cn help seizure disorders. For example, the medical community has long been aware that fasting improves and even eliminates seizures. In the early 1920s, R M Wilder introduced a diet intended to mimic the psychological effects of fasting. This diet consists of high amounts of fat (as much as 80 per cent of calories) and low amounts of protein and carbohydrate (no more than 20 per cent of calories) (Withrow, CD in Antiepileptic Drugs; Mechanisms of Anticonvulsant Action, G H Glaser, et al, ed., Raven Press, NY, 1980). Like fasting, it provokes ketosis, the production of certain acids called ketone bodies, which in the absence of dietary carbohydrates, will be metabolized instead of glucose as fuel for the brain (J Pediatrics, November 1976, 89 (5): 695-703). For this reason, it was named the ketogenic diet (KD). Ketosis is measured by testing the urine with dip and read sticks available in most chemists.

From early on, the KD showed clinical effectiveness in suppressing and avoiding seizures. Unfortunately, as it requires a great deal of effort to follow, and as even a small amount of extra carbohydrate can bring on seizures again within three and a half hours, the KD was eventually neglected in favour of anticonvulsant drugs.

Johns Hopkins Medical Center in Baltimore, Maryland, is currently using it with great success to treat intractable seizures. In one review of 58 cases, seizure control improved in 67 per cent of patients, and 75 per cent of these improved patients continued the diet for at least 18 months. Sixty four percent had AEDs (anti-epileptic drugs) reduced, 36 per cent became more alert and 23 per cent had improved behaviour (Epilepsia, 1992; 33 (6): 1132-6)

In St Louis Children’s Hospital, 50 per cent of patients on the KD, from seven months to 38 years, had become free of seizures, and another 20 to 30 per cent had experienced considerable improvement in seizure control ( Dev Med Child Neur, 1977; 19: 535-44).

A version of the KD developed in Booth Hall Children’s Hospital in Manchester requires that 50-70 per cent of the calories be given as medium chain triglycerides (MCT ), a type of oil, plus 11 per cent as other fats, plus 10 per cent protein and 19 per cent carboyhydrate, a more palatable combination. The MCT oil is recommended for frying, grilling and in baked foods; it’s also given as part of an emulsion to be sipped throughout meals, consisting of 200 ml MCT oil, 200 ml water, a teaspoon of powdered gelatin and skim milk. At first, this diet may provoke temporary abdominal pain, vomiting or diarrhea, but rarely any other adverse effects; when effective, it may permit the reduction of anticonvulsant drugs without a return of the seizures.

Some researchers speculate that the high fat intake helps repair the myeli sheath around the nerves, a structure that is damaged in such widely disparate conditions as multiple sclerosis and adreno leuko dystrophy (the illness shown in the movie “Lorenzo’s Oil”). Children with seizures need to remain very strictly on the diet, with not even the slightest deviation toward carbohydrates, for about two years. After that time, they can slowly widen their food intake.

A study from India includes the following daily foods used in the KD: butter and ghee, or clarified butter (6 oz); two eggs; bread and chapati breast (two pieces); whole milk (10 oz); meat or dal bean sauce (two oz); mixed vegetables (8 oz); and one orange. These foods could be divided as follows: for breakfast, one egg fried in 1/2 oz butter, one slice toast with 1/2 oz butter and 4 oz milk, with the orange as a midmorning snack. For lunch, you could have 4 oz mixed vegetables sauteed in 1 oz butter, 1 oz meat with 1 oz melted butter, and for afternoon snack 4 oz milk with 1 slice bread and 1/2 oz butter. Finally for dinner, the remaining 4 oz mixed vegetables could be sauteed in 1 oz butter, with 1 oz bean sauce in 1 oz ghee and 1 egg fried with 1/2 butter.

It goes without saying that you should never attempt this diet for you or a child or stop anti-convulsant medication without working in partnership with an experienced, qualified professional.

!AAnnemarie Colbin

The vaccine, given to millions of children every year, will triple the risk of a febrile seizure, according to a major Danish survey. The risk is at its greatest within two weeks of the child being vaccinated. After that, the risk drops to a similar rate found in a child who has never been vaccinated.

However, children who suffered their first seizure because of the vaccination had a 19 per cent chance of suffering further seizures afterwards, although researchers say there is no likelihood of the child developing epilepsy later.

Despite these reassurances, their claim doesn’t fit with the facts. Children who have recurrent seizures have a 4 per cent chance of developing epilepsy. The research team notes that the rate of seizure after the vaccine is far higher among children whose family has a history of epilepsy, which also suggests their dismissal of a link may need re-examining.

Febrile seizure is a relatively common occurrence among small children, and in most cases it is a harmless incident. Nonetheless it is extremely disturbing for everyone concerned. The child often loses consciousness, and starts to shake. Sometimes the child becomes rigid. A seizure can last anything from a few seconds up to 15 minutes.

The Danish study involved 537,171 children who were born in Denmark between 1991 and 1998. Of those, 439,251 had the MMR vaccine, and 17,986 children had at least one febrile seizure.

(Source: Journal of the American Medical Association, 2004; 292: 351-7).

* To find out everything you ever wanted to know about the MMR and other vaccines, you have to have your own copy of the WDDTY Vaccination Bible and the Special MMR Update Report. It’s a ‘must’ for every thinking parent. To order your copy, click on this link: http://www.wddty.co.uk/shop/details.asp?product=335

The first inquiry led to my being offered phenytoin as a replacement drug. The effects, however were so destabilizing that I returned to the phenobarbitone within a couple of days. On subsequent occasions when I approached my GP and asked to see a consultant, I was advised that as my epilepsy had been controlled by phenobarbitone, any change could lead to a destabilizing of the condition.

Last September I suffered a further grand mal seizure and underwent a series of tests in hospital, all of which showed “negative” results. The end result, however, was that a change in my medication was prescribed, and I am now being weaned off phenobarbitone and on to carbamazepine.

I have been unable to get clear answers to the question of the side effects of prolonged usage of phenobarbitone. D P, Exeter…….

I understand that the drug Epilim taken by mothers with epilepsy when pregnant can lead to an increased risk of babies being born with congenital abnormalities, such as cleft lip, spina bifida and even microcephaly. D J, Ilford…….

A:Epilepsy, as you know, is a condition in which the electrical circuitry of the brain produces too many charges, overloads and then short circuits, causing convulsions, abnormal behaviours, or sensations, depending on which part of the brain is affected.

Most anti convulsant drugs work by damping down brain cell electrical activity, in order to stop this build up. The idea is to stop the seizures without losing any brain function. But this is a delicate balancing act requiring that a doctor be highly educated in the various anti convulsant drugs, understand the kinds of seizures affecting a particular patient, and work with the patient as a partner in keeping a record of seizures, a regular monitoring of EEGs and also a monitoring of the levels and effects of the drug in the patient’s body.

Some doctors feel that a patient must take an anti epileptic drug for the rest of his life; others, that daily doses can be slowly reduced by steps every few weeks in patients who have remained seizure free for two years and finally stopped if no seizures have occurred during that time.

Phenobarbitone carries a host of serious risks. Among the laundry list of side effects they can cause: Parkinsonian effects (involuntary movements), impaired judgement, drowsiness, allergic reactions and depressed breathing. In long term use among epileptics they can cause folic acid deficiency anaemia and possibly liver damage. They are particularly worrisome in people with kidney, liver or chest disease. One paradoxical effect is to occasionally produce excitation and restlessness.

Of course the big problem with barbiturates is that they cause dependency. You can also develop a psychological dependence . If the drug is stopped suddenly, you can experience anxiety, headaches, tremors, stomach cramps, vomiting, insomnia and rapid heart beat. Phenobarbitone has been known to cause confusion, hallucinations and mental depression, and all sleeping pills cause memory problems.

Carbamazepine is now being offered as a more modern alternative to the early anti convulsants. If too high a dose is started too quickly it can cause dizziness and double vision. Other side effects include stomach and intestinal problems, serious blood disorders, fluid retention, visual disturbances, drowsiness and, in rare cases, jaundice and kidney damage. It should never be used in people with heart problems or those with impaired liver function. You must have regular blood tests when you first go on it.

A randomized study published in the New England Journal of Medicine (21 January 1993) found no difference after three years in efficacy between phenobarbital, phenbytoin, carbamazepine and valproate in children and adults with newly diagnosed generalized seizures.

There is a good argument for your staying on phenobarb because it’s been around for 20 years and we know most of what it can do to you. Also if you’ve been taking it for 20 years, you’ve probably developed all the side effects you’re going to.

However, the main problem appears to be the attitude of your doctor. Good epilepsy management results from the partnership of a trained consultant like a neurologist working in tandem with the patient to keep vigilant track of the patient’s reaction to the drugs. Furthermore, many people are put on epileptic drugs when they are young and may outgrow the need for the drug or even the dosage they started on. It is vital that you be placed in the hands of a highly experienced neurologist who will work with you on drug management. You might also have your calcium and magnesium levels checked and also a test done for low blood sugar, since low levels of any of these can bring on seizures.

As for Epilim (which is sodium valproate), the Physician’s Desk Reference, which is obliged by American law to print full explanations about its products, says that all antiepileptic drugs can cause birth defects. Specifically, it says valpoic acid “may produce teratogenic effects in the offspring of human females receiving the drug during pregnancy. . . . Therefore, antiepileptic drugs should be administered to women of childbearing potential only if they are clearly shown to be essential in the management of their seizures.”

The Centers for Disease Control (CDC) has estimated the risk of valproic acid exposed women having children with spina bifida to be approximately 1 to 2 per cent. This risk is similar to that for nonepileptic women who have had children with neural tube defects. In animal studies there have been reports of increased incidence of cleft lip and palate, and heart malformations.

If you have epilepsy, and wish to get pregnant, it’s vital to get to a highly experienced neurologist who can keep you on a greatly reduced level of the drug or determine before you get pregnant whether you can stay off the drug during your pregnancy.

A lot of people are kept on drugs for a lifetime only because they’ve had a minor fit in their childhood.

(Note add info about Epilepsy check to grossly calcium and magnesium or hypoglycemia. Stick with traditional consultant. Improve general health)

A:Thank you for your letter and the highly informative articles you sent, which we’ll elaborate for the benefit of our readers. In one, experts at Birmingham Children’s Hospital concluded that about half of cases of so called juvenile epilepsy are wrongly diagnosed (The Observer, December 1992). This is significant, as more than half the 340,000 epilepsies in Britain are believed to begin in childhood.

Dr Michael Prendergast, consultant child psychiatrist at the Children’s Hospital, examined 311 children referred to the hospital for suspected or diagnosed epilepsy and discovered that 138, or 44 per cent, of the children didn’t have it.

His results are nearly identical to those of a Scottish study completed in 1896 by the Royal Hospital for Sick Children in Glasgow. In that study, Dr John Stephenson, the hospital’s consultant pediatric neurologist, found that 47 per cent of the children referred there didn’t in fact have epilepsy.

Also for the benefit of our readers, please allow me to recount your story. Jacqui, now 36, was diagnosed as having epilepsy when she was 11, after suffering several blackouts. She was immediately placed on anti-convulsants, although the first convulsion didn’t appear until after she’d been on the drugs. She has spent years battling the myriad of drug side effects, including blackouts and convulsions. From 1988, when she began reducing the dosage of the drugs she was taking, the seizures have correspondingly reduced, from 200 to several dozen.

Although doctors these days claim to be more cautious about automatically handing out anti-convulsant drugs to children with mild blackouts and seizures, the conventional wisdom among most doctors still is that, until suppressed by drug treatment, seizures will recur, and that drug treatment can affect the course of the disease, reducing the risk of early epilepsy turning into an intractible disorder.

This viewpoint does have some preliminary evidence, according to a review paper by E H Reynolds, consultant neurologist at the Centre of Epilepsy in Maudsley Hospital in London. Reynolds quoted several studies showing that the more seizures, the worse the prognosis (Epilepsia, 1989; 30: 648), and that patients with single seizures did better at least over the medium term when they got drugs, compared to those who’d been given placebo or had treatment delayed (Clin Neurol Neurosurg 1992; 94 (suppl): S61-3); Neurology, 1993; 432: 478-83).

Nevertheless, in that same issue of the British Medical Journal (January 21, 1994) David Chadwick, professor of neurology at Walton Centre for Neurology and Neurosurgery in Liverpool, presents a strong counterargument for holding off early treatment. For one thing, he argues, epilepsy is an umbrella term referring to a group of disorders, and not a single, homogeneous disease. In some cases of epilepsy, such as “benign rolandic epilepsy” in children, where seizures only affecting the face, throat and arm occur during sleep, there is strong evidence that the seizures stop by themselves by mid adolescence. Furthermore, the preliminary data suggesting that people are better off getting drugs after early treatment is far from “definitive”.

Among the very few longer term studies examining which factors predicted at least a five year seizure free remission, one found that developing epilepsy before age 16, having no evidence of brain damages, tonic-clonic (grand mal) seizures or spike wave abnormalities on an electroencephalogram (EEC) in other words, your very situation were all factors that tended to favour remission, whether or not drugs were given (Epilepsia, 1988; 29: 590-600). It should be noted that the situation is very different with other forms of epilepsy, such as juvenile myoclonic epilepsy, he says, where patients who’ve had grand mal seizures have a high probability of relapse if the drugs are withdrawn.

As Chadwick emphasizes, it’s very difficult to know whether drugs given early make any difference because untreated epileptics are difficult to find. But those studies that are performed suggest that drugs make virtually no difference. In one small study of 33 untreated patients, after 20 years half the group (52 per cent) had gone into “remission” a percentage which is equivalent to those given drugs (British Medical Journal, 1993; 307: 483). Similar remission rates occurred in a group of 302 patients in Africa and 192 patients in Ecuador; where treatment was delayed, six month remission rates were the equivalent of populations given early drug treatment (The Lancet, 1991; 337: 406-9; Epilepsy Res; 1993; 14: 237-44).

Scientific trials (ie, randomized clinical trials) about early treatment support your views that patients taking drugs may be actually worse off. In one study, which gave patients with seizures after head injury either the epilepsy drug phenytoin or a placebo, the patients taking the drugs had more seizures than the control group (New Eng J Med, 1990; 323: 497-502). In a recent Italian multicentre study, 400 patients were randomly assigned to treatment or a placebo. Although the treatment group had half the risk of having a further seizure, thus far there is no evidence of any difference between the two groups in terms of time taken for remission (Neurology, 1993; 43: 478-83).

In other words, doctors don’t have enough information to encourage early treatment with certainty.

As you undoubtedly know, all epileptic drug treatment carries a host of potentially lethal effects.

The latest study (J Neurol Neurosurg Psychiatry, 1995; 58: 44-50) shows side effects were so serious that nearly a quarter of patients on phenobarbitone, and 11 per cent of those on carbamazepine, had to be taken off the drugs. As the apparent safest of the four, the study concluded that phenytoin was the first drug of choice.

One highly overlooked treatment not involving drugs concerns the little known connection between epilepsy and celiac disease, or an intolerance of gluten containing grains wheat, oats, barley and rye. Although numerous studies have produced this association, the largest study to date of patients with epilepsy found that 77 per cent passed the test for celiac disease (The Lancet, 1992; 340: 439-43). A biopsy of the small bowel found the characteristic atrophy of the villi, or tiny hairs of the gut.

Furthermore, although the patients had been diagnosed with epilepsy before the connection with celiac disease had been diagnosed, most demonstrated symptoms of malabsorption. Seizures stopped or were halved in frequency in a third of patients after they embarked on a gluten free diet. Those who were most successful were younger and had epilepsy for a shorter amount of time, suggesting that the one way that early diagnosis may improve matters is making the celiac connection.

To find out if you do, a kinesiology muscle test can quickly give you the answer, says one correspondent. If the test shows you have the worm, one antidote could be Citricidal (grapefruit seed extract) suggests one reader, while another has a one-word solution – graviola, she says. Right, then.

Another woman suggests (in less concise terms) a programme that includes black walnut (Juglans regia), wormwood and cloves. She worms her dogs with the same solution she uses to ‘worm’ herself. Interestingly, her dog suffered seizures three or four times a month (possibly from the worms) and was also treated homoeopathically, and with great success.

In one case, the child went for his regular appointment with his paediatrician, who commented on how much calmer the lad was and asked what had happened to bring about the change.

On being told about the new diet, the doctor said the child should eat whatever he wanted. Soon afterward, I had a frantic phone call to say the boy was “fitting all over the place”, and “running around on tippy-toes again” – this had also stopped on the new diet. The hospital had wanted to operate and cut the tendons at the back of his heels as he had never walked normally – until the new diet.

The Great Ormond Street hospital studies of the 1980s found that epilepsy could be caused by diet (see the American Journal of Pediatrics, 1989; 114: 51-8). – V.K., Knaresborough

SJS is a hypersensitivity reaction of the skin and mucous membranes, some 15 per cent of which end in death. TEN, characterised by skin blistering and peeling, may also be fatal. While SJS and TEN are usually rare (0.5-6 cases per million population), patients taking Trileptal increase their risk by 3-10 times.

Life-threatening multiorgan (usually blood, liver and kidney) hypersensitivity has also been seen with the drug. Patients typically have fever and a rash.

If any of these adverse reactions is suspected, Novartis recommends discontinuing Trileptal immediately.

Half were given rectal diazepam (Valium) gel, and the rest were given a placebo. Response was not that impressive among the adults, but the children responded well to the treatment. Sleepiness, however, was a common side effect.

The researchers recommend that it can be safely administered at home by a trained “care giver”, such as a parent (N Engl J Med 1998; 338: 1869-75).