an epileptic seizure is defined as a transient symptom of abnormal excessive or synchronous firing of some or many of the brain s cells , or neurons .
the outward effect can be as dramatic as convulsions with wild thrashing movements ( tonic - clonic seizure ) or as mild as a brief loss of awareness ( absence seizure ) .
sometimes seizures consist of repeated full body  slumps ,  with the person simply losing body control and crashing to the ground .
it has been found that initial , thoughtfully chosen medication can make almost 50 percent of patients seizure - free for extended periods of time . if an initial drug fails , another well - chosen drug may make an additional 14 percent of patients seizure - free .
if that drug fails , too , then the likelihood of rendering someone with epilepsy seizure - free is poor . more than 30 percent of patients with epilepsy will not have seizure control even with the best available medications . despite the introduction of many new anticonvulsant medications , these figures have remained consistent over time . working with families
whose children had epilepsy , we realized that there were no books written for parents to help them cope . to fill the void , my colleague , eileen vining , m.d . , my coordinator / counselor , diana pillas , and i decided to team up to write one .
the result was seizures and epilepsy in childhood : a guide for parents,3 published by the johns hopkins press in 1993 .
it contained three pages on the ketogenic diet . sensing a need for a separate book that focused solely on the diet , the dietitian millicent kelly and i collaborated with my daughter , jennifer freeman , a freelance writer , to write the epilepsy diet treatment : an introduction to the ketogenic diet , a shorter book specifically about the ketogenic diet .
it was 1993 , and charlie abrahams , the two - year - old son of jim abrahams , the hollywood producer of airplane and naked gun , continued to suffer many uncontrollable drop seizures each day , despite extensive medical intervention .
as abrahams has stated ,  after thousands of epileptic seizures , an incredible number of drugs , dozens of blood draws , eight hospitalizations , a mountain of eegs , mris , cat scans , and pet scans , one fruitless brain surgery , five pediatric neurologists in three cities , two homoeopathists , one faith healer , and countless prayers , charlie s seizures continued unchecked , his development delayed , and he had a prognosis of continued seizures and progressive retardation . 
researching epilepsy treatments himself , abrahams found our book , seizures and epilepsy : a guide for parents,3 with its three pages on the ketogenic diet .
after a phone call , he brought charlie to johns hopkins , where the toddler first fasted , according to our protocol . within several days
gradually taken off his medications , charlie has remained seizure - free , on no medications , for the past 19 years .
jim was outraged that in all his conversations with medical experts and other parents , he had never been told of the diet .
determined to make information about the ketogenic diet available to parents and physicians , he was instrumental in bringing the 1994  dateline nbc  news magazine program ,  an introduction to the ketogenic diet ,  featuring his friend , the actress meryl streep , to the public .
the foundation funded a seven - year study and published 2,500 copies of our shorter book , which sold quickly and attracted a more established publisher , demoshealth .
the foundation also funded the production of several dvds explaining the diet to parents , dietitians , and physicians . despite offering them free to physicians at national and regional epilepsy meetings
, there were few takers  a sign that much work still needed to be done . a big breakthrough in promoting the diet finally came in 1997 , when an abrahams - directed , made - for - tv movie , 
first do no harm ,  also with streep , was followed by a flood of thousands of phone inquiries and about 150 patients seeking help with the diet from johns hopkins .
the new patients allowed us to gather important data about the diet s effectiveness and its side effects .
the reports from johns hopkins were the first of an avalanche of abstracts and articles on the clinical outcomes of children who were treated , including outcomes of the diet s various aspects and modifications .
the huge increase in the number of clinical abstracts was presented annually at american epilepsy society meetings .
the foundation has since been the moving force behind increasing physicians knowledge about the diet and in training parents and dietitians in its use . at the third international conference on dietary therapies for epilepsy and other neurological disorders , organized by the foundation in 2012 , close to 500 physicians , dietitians , and parents from 30 countries around the world honored streep for her role in reintroducing the diet .
the conference  promoted in the foundation s newsletter , ketonews  included cooking demonstrations and exhibits , testimonials from parents , and a professional symposium .
at first , most epileptologists did not believe that a diet could be as effective as drugs , although multiple large studies documented the diet s effectiveness .
but these studies were uncontrolled , and since many were based on the large johns hopkins patient population , there was a tendency for physicians to discount the results as biased by enthusiasts . finally , two blinded crossover studies 
one from the cross group in england4 in 2008 , the other funded by the national institutes of health at johns hopkins in 2009documented the diet s effectiveness in children in a controlled fashion .
although there are currently no large studies in adults , anecdotal reports indicate the diet s effectiveness , although it appears adults have more difficulty adhering to its rigidity.5 the outcome of children with uncontrolled seizures who are placed on the diet is shown in the figure ( see below ) , which summarizes data from johns hopkins studies6 and is similar to many reports from other centers .
it is notable that 33 percent of the children with intractable seizures were seizure - free , or had only rare seizures , after being on the diet for one year , and 27 percent of the children whose seizures had previously been uncontrollable by medications had no seizures or only rare seizures three to six years after initiating the diet , although by that time most of the children were off the diet and all medications .
some with continued seizures remain on the diet because it has decreased the number of medications the children need to take as well as the consequent side effects .
no anticonvulsant drugs have been studied for that duration or have shown that rate of beneficial effects .
the diet is rarely used as the initial treatment for epilepsy , but should be strongly considered when two anticonvulsants , properly used , have failed .
however , the diet may be the initial treatment of choice in infantile spasms and other 
despite considerable recent research , how the diet exerts its beneficial effects remains unknown.6 it is not solely the ketosis , the accompanying acidosis , the lipidosis , or any of the other chemical changes that have been investigated that are responsible .
a recent study9 suggests that episodic fasting , in addition to the diet , is even more effective than the diet alone in controlling seizures .
learning the mechanisms by which the diet controls epilepsy may give us a better understanding of epilepsy itself .
modifications of the ketogenic diet , such as the modified atkins diet , the medium - chain triglyceride ( mct ) diet , and the low - glycemic diet ( lgd ) have been developed as alternatives to the rigidity of the classic version .
these diets , all of which have been found to have degrees of effectiveness , may be more acceptable to adolescents and adults.5 although large studies of these diets have yet to be performed , uncontrolled studies suggest that they may be effective .
if tried , and the individual s seizure control is less than satisfactory , the more rigid , classic ketogenic diet is recommended.1 while the classic ketogenic diet may cause complications1 such as kidney stones,9 lipidemia , and gastrointestinal symptoms , problems are rarely serious and easily managed .
vomiting is common in the early stages of fasting and may be relieved with small doses of glucose .
constipation is common and may be relieved with small amounts of medium - chain triglyceride oil ( mct ) or a readily available laxative such as miralax .
carnitine is rarely needed , but sugar - free multivitamins and minerals such as calcium are recommended .
calcium oxalate and uric acid kidney stones occur in 15 to 20 percent of patients and can be treated or prevented by the administration of potassium citrate .
plasma lipids are also known to rise slightly , but they return to normal levels after six months .
the rare patient with familial dyslipidemias has been seen , and therefore lipid levels should be checked occasionally.1 generally , children whose seizures are controlled by the diet are tapered off it after two years .
but if seizures continue , or recur , the child should remain on the diet longer .
some patients have remained on the diet for more than 25 years without adverse effects .
the resurgence of interest in the ketogenic diet has led to some very preliminary studies of its use in conditions other than epilepsy .
neurodegenerative disorders provide a unique opportunity to study cellular protection through diet.6.9,11 animal models and anecdotal human reports suggest that glucose restriction and the ketogenic diet may have beneficial effects on brain tumors.7,8 tumors rapidly metabolize glucose but are unable to utilize ketones as an energy source . brain tissue , on the other hand , is able to use both .
glioblastoma implanted in rodents rapidly regresses on a glucose - restricted ketogenic - like diet .
anecdotal reports and preliminary studies in humans have found tumor regression on ketogenic diets . the dramatic findings in glioblastoma may also be true of other brain tumors and perhaps other systemic tumors .
there are also anecdotal reports of the diet s benefits6,9,11 in modifying alzheimer s disease , parkinsonism , amyotrophic lateral sclerosis , and possibly posttraumatic brain injury , stroke , and severe hyperactivity .
however , such studies are needed to prove or disprove the diet s usefulness . the diet , or a modified form of it , may also be useful in the management of diabetes .
preliminary reports of its use in inflammatory disease and the management of pain are also of interest and deserve further study.6 although it has taken 20 years to reintroduce the once - abandoned ketogenic diet , it has become an important new therapy  especially for difficult - to - control seizures in children . as more
dietitians are trained , and more physicians become aware of the diet , it is used increasingly throughout the world.1 guides to its use are now available in many languages and in many countries , thanks to the charlie foundation and its british cousin , matthew s friends .
the idea of food as medicine has been a controversial topic in this country for many years .
but the statistics do nt lie , nor do the hundreds of young people who will tell you how their lives were changed because of it .
 editor s note : epilepsy and seizures affect nearly 3 million americans of all ages . 
 the incidence is greater in african - americans and in socially disadvantaged populations , and about 200,000 new cases of epilepsy are diagnosed each year . despite these alarming figures , no magic pill exists to eliminate convulsions . while drugs work for some , others find them ineffective . 
 what seems to work just as well , if not better , especially in children , is a relatively unknown , high - fat diet . 
 the author , john m. freeman , m.d . 
 , one of the nation s leading advocates for its use , writes about the evolution of the diet and its struggle for acceptance . 
Diet vs. Drugs
A New Foundation
Anecdotal and Empirical Evidence
Other Ketogenic-like Diets
Other Possible Uses