was held in Phoenix, Arizona from April 2â5, 2008. This supplement .... generous support of this important symposium and the facilitation of the present Epilepsia ...
Epilepsia, 49(Suppl. 8):1–2, 2008 doi: 10.1111/j.1528-1167.2008.01820.x
SUPPLEMENT - KETOGENIC DIET AND TREATMENTS
Introduction/perspectives ∗ ∗
Carl E. Stafstrom, †Beth Zupec-Kania, and ‡Jong M. Rho
University of Wisconsin, Madison, Wisconsin, U.S.A.; †The Charlie Foundation, Ketogenic Diet Seminars, Santa Monica, California, U.S.A.; and ‡Barrow Neurological Institute, Phoenix, Arizona, U.S.A.
The first International Symposium on Dietary Treatments for Epilepsy and Other Neurological Disorders was held in Phoenix, Arizona from April 2–5, 2008. This supplement comprises a summary of presentations at the symposium, describing advances in dietary therapies for epilepsy from both clinical and basic science perspectives. The story of the ketogenic diet (KD) is a remarkable one, a saga as compelling as any in clinical medicine. From both teleological and evolutionary perspectives, it makes abundant sense that dietary factors should be important in influencing brain physiology. The aphorism “we are what we eat” is a popular reminder that our station in life is often correlated with the perceived rarity and value of foodstuffs available for personal consumption. However, “what we eat” has become an even more timely consideration given the recent dramatic increase in obesity seen in both children and adults living in the United States—an ominous development that heralds an impending epidemic of longterm health consequences such as diabetes and cardiovascular disease. Further, the attainment of significant weight loss and a lean body habitus—a mantra promulgated by the media—has become a psychological holy grail, one that promises bountiful happiness and self-esteem, despite potential negative health effects of nutritional deprivation. This dichotomy of physical extremes—the obsession with food or its avoidance—represents the sociological and historical backdrop against which the KD has emerged as a “rediscovered” therapy for medically refractory epilepsy. Despite the intrinsic appeal of enhancing diet and nutrition, the topic of dietary therapies for epilepsy has only recently received serious attention in scientific circles. Indeed, the entire subject of metabolic control of neuronal excitability has only begun to mature within the last several years. Growing interest in the KD (and its variants) in the United States has been paralleled by explosive growth of clinical KD programs throughout the world. Thus, given these exciting developments, the organizers of this symposium felt that it was timely to convene both clinicians and
research scientists to share the cumulative knowledge and experience acquired to date regarding the impact of diet on neurological disorders (most notably, epilepsy). While there have already been a few small international meetings devoted to the topic of the KD, none have comprehensively examined both clinical and basic science aspects of this time-honored treatment. The fundamental goal of this international meeting was to enable the nearly 300 participants to share up-to-date information on the rapidly expanding topics of dietary therapies for epilepsy and metabolic regulation of neuronal excitability. Further, many of the discussions (both formal and informal) held during this meeting constituted the framework for delineating the important clinical and research questions that should be pursued in the future. This symposium provided a forum for extended discussions regarding practical clinical implementation, surveillance of adverse effects, and importantly, a critical look at basic cellular and molecular mechanisms that could account for the anticonvulsant and neuroprotective effects of the KD. The major topics discussed in both plenary and mini-symposium presentations are contained with this volume in succinct mini-reviews. It has been nearly 15 years since the KD experienced a dramatic resurgence of interest from both professionals and the lay public. The prime catalyst was the “Dateline NBC” television story of Charlie, a young boy who failed conventional therapies for his infantile-onset epilepsy, including numerous anticonvulsant medications and one surgical intervention. However, he achieved seizure freedom and remarkable neurodevelopmental recovery with the KD. One of the highlights of the international symposium was the appearance of Charlie, now a strapping 17-year-old high school honors student. Charlie electrified the audience with a plenary speech recounting his experience, in which he expressed his profound gratitude to the dietitians, physicians, nurses, and other health care providers who treated him with the KD.1 Charlie described how the KD abated his seizures, allowed him to discontinue antiepileptic drugs (AEDs) and, in essence, gave him his life back. To quote Charlie, “I was one of the few lucky ones. Since the diet was invented there have been millions of kids all over the world just like me, who were as sick as I was, but whose families either never heard about the diet or were talked out of it.” The initial impact and enduring legacy of Charlie’s
1 In particular, Charlie thanked Dr. John Freeman, Diane Pillas, and Millicent Kelly (dietitian) at Johns Hopkins Hospital.
Wiley Periodicals, Inc. International League Against Epilepsy
C 2008
1
2 C. E. Stafstrom et al. personal story cannot be understated. One only needs to appreciate the countless patients, families, and health-care professionals whose lives have been permanently altered by the KD, and the impressive spike in research publications, which began in the mid 1990s and continues to this day. The organizers wish to thank our sponsors for their generous support of this important symposium and the facilitation of the present Epilepsia supplement. Major funding for this international symposium was provided by The Charlie Foundation (based in Santa Monica, CA, U.S.A.), SHS/Nutricia North America (based in Gaithersburg, Maryland), the National Institutes of Health (National Institute of Neurological Disorders and Stroke), the American Epilepsy Society, CURE (Citizens United for Research in Epilepsy) Foundation (based in Chicago, IL, U.S.A.), The Epilepsy Therapy Project, Abbott Laboratories, and UCB Pharma. Special thanks go to Lindsey Kerby (Barrow Neurological Institute) for her role as conference manager and organizer. We wish to extend our heartfelt gratitude to Jim and Nancy Abrahams and The Charlie Foundation, a nonprofit organization established in 1994 whose primary role has been to facilitate scientific investigation, educate professionals, and serve as an incomparable resource for families about the KD. As plans are currently being drawn for the next major international symposium, we ask that the reader re-
Epilepsia, 49(Suppl. 8):1–2, 2008 doi: 10.1111/j.1528-1167.2008.01820.x
flect for a moment on the expanding literature attesting to the health benefits of calorie restriction, ketosis, and the ingestion of polyunsaturated fatty acids. At both clinical and basic science levels, it is increasingly apparent that a multitude of dietary factors can have a profound impact on disease risk and progression. Given the potential of the KD to protect neurons from seizure-induced injury or death, whether this is a consequence of diminishing the damaging effects of seizures or direct neuroprotective activity, it might be more accurate to state that “we become what we eat.” The organizers fervently hope that the success of this international symposium—a product of the recent phenomenal expansion of clinical programs and focused research activity—will continue to fuel even greater interest in and growth of the KD in the coming years.
ACKNOWLEDGMENT We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Drs. Stafstrom and Rho have received grant support from the Charlie Foundation. Ms. Zupec-Kania is a paid consultant to the Charlie Foundation and to Children’s Hospital of Wisconsin. She has received an educational grant from SHS/Nutricia. Dr. Rho is on the speaker’s bureau for UCB Pharma and Ortho-McNeil. He is on the advisory board for SHS/Nutricia and Questcor.
