Ketogenic Diet & Other Treatments for Neonatal Seizures

Neonatal seizures can be very difficult to recognize. This page contains general information about seizures, but is not meant to be used as a diagnostic tool. Also, we cannot provide medical advice. We are not doctors, and our live chat service should not be used for medical emergencies.

If you think that your child is currently having or has recently had a seizure for the first time, please call 911 for immediate medical attention. Infant seizures are serious conditions and require the care of a medical professional.

It is very important to treat seizures in a baby because seizures can cause brain damageHypoxic ischemic encephalopathy (HIE) is the most common cause of seizures during the neonatal period, and many babies with HIE and seizures are later diagnosed with cerebral palsy, intellectual disabilities, developmental delays, and hydrocephalus.  Almost half of all children with cerebral palsy have a seizure disorder.  Cerebral palsy is the most common cause of physical disability in childhood, and a seizure disorder / epilepsy is the most common childhood neurologic condition.

THE KETOGENIC DIET IS AN EFFECTIVE TREATMENT FOR NEONATAL SEIZURES.

When anti-seizure medications are not well-tolerated by the baby or are not adequately controlling the baby’s seizures, a ketogenic diet may be considered.  Research has consistently shown the ketogenic diet to be effective in reducing the incidence of seizures in adults, children and babies.  In fact, research shows that the infant brain may be able to obtain greater benefits from this diet than the adult brain.  The ketogenic diet is typically used for babies with intractable seizures (seizures that don’t respond to medication), but there are other instances in which this diet may be appropriate, such as when the baby experiences adverse reactions to anti-seizure medication.

Children with infantile spasms respond best to the ketogenic diet.  Infantile spasms can be caused by birth injuries, such as a brain infection (encephalitis or meningitis) or hypoxic ischemic encephalopathy (HIE).  This type of seizure is very serious because it often involves the baby having seizures in clusters of up to 100 spasms at a time.  Babies may have dozens of clusters and several hundred spasms per day.  As seizure duration, frequency and severity increase, so do the risks of permanent brain damage in the baby.

Indeed, the ketogenic diet is a safe and effective treatment for babies who have seizures that are not easily controlled by anti-seizure medications.  The diet consists of a high-fat diet with very few carbohydrates and adequate protein.  The ketogenic diet is believed to trigger biochemical changes that eliminate the short circuits in the brain’s signaling system that causes seizures.  The effectiveness of the diet is largely due to the ketones it causes the body to produce.  Babies can be fed a formula-only ketogenic diet.

Many neurologists feel that the ketogenic diet is an effective treatment that is probably underutilized.  The diet does, however, cause some metabolic changes that may adversely affect a child’s cholesterol level, bone development, growth and weight gain.  Thus, the ketogenic diet should only be undertaken with the supervision of the baby’s physician and regular tests to assess the impact of the diet on the child.

h as hypoglycemia, isn’t treated, medication may not be effective.  Anti-seizure medications can be toxic to an infant’s brain, so physicians must be very careful when giving these medications to babies.  Researchers recently did an in-depth examination of neonatal seizure medications, and they found the following:

  • Medications that do not contain compounds toxic to the baby’s brain should be used.  Hospitals should have specific guidelines for use of seizure medications.
  • The first choice for seizure treatment is a medication called phenobarbital because physicians have much more experience with it.
  • The newer drugs levetiracetam and topiramate seem promising in babies who cannot tolerate phenobarbital.
  • In most cases, term babies should receive different medications than premature babies because they have different channels in the brain.
  • Babies receiving hypothermia treatment for hypoxic ischemic encephalopathy (HIE) must be assessed differently than babies not receiving HIE treatment.  Topiramate may be beneficial when administered along with hypothermia treatment.
  • A medication called bumetanide seems to be the most promising for term newborns due to its very specific mode of action.  In addition, research indicates that bumetanide used in combination with phenobarbital may actually reverse damage in the brain caused by seizures.
  • Dosages for anti-seizure medications should be based on gestational age.
  • Seizures must be timely controlled, and when possible, treatments that protect the brain should be used.

 

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