Keto4 Epilepsy

The ketogenic diet was first introduced as a treatment for epilepsy in the 1920s. Here are the key details about the original role and development of the ketogenic diet:

Origins and Initial Purpose

The ketogenic diet was developed specifically as a therapeutic treatment for epilepsy, particularly in children. Its creation was inspired by the observation that fasting could reduce seizures in some epilepsy patients[1][2].

Development Timeline

In 1921, Dr. Russell Wilder at the Mayo Clinic coined the term "ketogenic diet" and proposed it as a way to mimic the metabolic effects of fasting while allowing the diet to be maintained long-term[2][4].
Wilder hypothesized that the diet could be as effective as fasting for treating epilepsy by inducing a state of ketosis in the body[4].
The diet was designed to be very high in fat (70-90% of calories) with very limited carbohydrates and protein, forcing the body to use fat as its primary energy source instead of glucose[2].

Early Implementation and Success

In the 1920s, the ketogenic diet was widely adopted as a treatment for epilepsy after Wilder and his colleagues at the Mayo Clinic successfully tested it on both children and adults[4].
Dr. Mynie Peterman, also from the Mayo Clinic, established the techniques for implementing and maintaining the diet in the 1920s[2].
In 1925, Peterman reported that 95% of 37 young patients had improved seizure control on the diet, with 60% becoming seizure-free[2].

Decline and Revival

The diet's popularity waned in the 1940s with the introduction of new anticonvulsant medications[2].
However, it experienced a revival in the late 20th century, particularly for treating drug-resistant epilepsy in children[1][4].

[1] https://www.epilepsy.com/treatment/dietary-therapies/ketogenic-diet

[2] https://en.wikipedia.org/wiki/Ketogenic_diet

[3] https://www.sciencedirect.com/science/article/abs/pii/S152550501930914X

[4] https://www.hopkinsmedicine.org/neurology-neurosurgery/specialty-areas/epilepsy/keto-diet-timeline

[5] https://pubmed.ncbi.nlm.nih.gov/19049574/

The ketogenic diet and modern anticonvulsant medications are both used to treat epilepsy, but they work in different ways and have different efficacy profiles:

Efficacy

Modern anticonvulsant medications can control seizures in about 70% of people with epilepsy[12][13]. However, about 30% of patients have drug-resistant epilepsy that does not respond adequately to medications.
The ketogenic diet has been shown to reduce seizures by 50% or more in about 50-60% of children with drug-resistant epilepsy[10][11]. In some studies, up to 15-20% of children on the diet became seizure-free.
For adults, the ketogenic diet appears to be less effective, with about 30-40% experiencing a 50% or greater reduction in seizures[10].

Mechanism of Action

Anticonvulsant medications typically work by altering neurotransmitter activity or ion channels in the brain to reduce neuronal excitability[13].
The ketogenic diet forces the body to use fat for fuel instead of carbohydrates, producing ketones. The exact mechanism is not fully understood, but it's thought to alter brain metabolism and neurotransmitter levels[1][6].

Side Effects

Anticonvulsant medications can have various side effects including dizziness, fatigue, cognitive issues, and liver/kidney problems[13].
The ketogenic diet can cause constipation, kidney stones, growth slowing in children, and high cholesterol[1]. However, it avoids the systemic side effects of medications.

Ease of Use

Medications are generally easier to administer and adhere to long-term compared to the very restrictive ketogenic diet[14].
The ketogenic diet requires strict compliance and careful monitoring, especially in children[14]. Modified versions like the modified Atkins diet may be easier for adults to follow[11].

Time to Effect