Leah’s Story: Epilepsy & the Ketogenic Diet

My precious daughter, Leah, is 13 years old. She loves to listen to music and swim. She also enjoys riding her golf cart with her brothers, Noah and Elijah, and her little sister Eden. She enjoys listening to the birds while relaxing on her swing outside.

Concerning Symptoms

Leah was developing on track and meeting all milestones until she was around 5 ½ months old. On Labor Day of 2005, I noticed Leah’s eyes were rolling up and to the right. Since Leah is my third child, I knew that something was off and that it wasn’t normal. I actually worked in Leah’s pediatrician’s office and mentioned it to the pediatrician at work the following afternoon. My husband, Brandon, and I brought Leah into the clinic the following morning. The pediatrician discovered that Leah wasn’t visually tracking with her right eye and referred us right away to a pediatric ophthalmologist at a children’s hospital 2 hours away. The ophthalmologist thought Leah might have delayed visual maturation. He wanted to monitor her and keep an eye on it over time.

At Leah’s 6-month check-up, Leah’s pediatrician discovered that she wasn’t visually tracking with either of her eyes anymore. The next couple of months were pretty busy. After more appointments and exams, they discovered that Leah developed cortical visual impairment. As time went on, we also noticed that Leah wasn’t developing properly and was showing some regression. We saw a neurodevelopmental pediatrician. He could see something wasn’t right, but wasn’t sure what was going on. He did some testing, labs, and recommended a referral to a pediatric neurologist.

Then, in November, before we could meet with the pediatric neurologist, I was holding Leah when I noticed that she was throwing her head, arms, and legs outward in a rhythmic pattern. I started counting them. It was happening in clusters every 8 seconds. I thought she was having a seizure. The Internet wasn’t widely used in our rural area back in 2005, so I asked my Aunt Jamie to help look some things up for me. We found some information on Infantile Spasms, also known as West Syndrome, and thought it sounded a lot like the symptoms we were seeing with Leah.

Infantile Spasms

The following morning, I told Leah’s pediatrician that I thought Leah had Infantile Spasms. I told her about the episodes the previous night and she agreed that it sounded exactly like Infantile Spasms. She said it would need to be diagnosed with an electroencephalogram (EEG), but that it would explain Leah’s recent symptoms and developmental regression. The pediatrician called the neurologist that Leah was scheduled to see in a couple of weeks, who agreed that it sounded like Infantile Spasms. She said sometimes it takes a little while to show up on an EEG and to keep our appointment we had scheduled. By that time, if it was Infantile Spasms, it would more than likely show on the EEG.

Fast forward to appointment day. Leah was scheduled for an EEG and another test called a visual evoked potential (VEP) in the morning, and then to see the neurologist in the afternoon. After the first two tests, the EEG tech told us that she had to call the neurologist. I knew then that she saw something abnormal. She came back in and said that the neurologist wanted her to do one more test. After that was done, we had lunch, then went to the neurology clinic for Leah’s appointment. The neurologist told us that our suspicion was right and officially diagnosed Leah with Infantile Spasms.

Leah’s neurologist recommended a medication called ACTH for Leah and told us that it wasn’t a medication that they kept on hand at the hospital so it would need to be ordered in. She explained that Leah would need to be admitted to the hospital to start the medication and that we would be trained to give the injections at home. She told us to go home, make arrangements for our boys, pack a bag, and come back the following afternoon. We were scared, but mostly relieved that we finally had an answer. It took a little while, but the ACTH stopped the Infantile Spasms. Leah had some feeding difficulty, reflux, and was very developmentally delayed, but was doing pretty well otherwise. She had a lot of therapies through Early Intervention each week. She started preschool and was learning new skills.

Seizures Return

Five years later, shortly after Leah turned 5 years old, I had a flashback to November of 2005. I was holding her on my lap one evening and I felt rhythmic moving. Her right shoulder was moving back and her head kept turning to the right. Like years before, I started counting and got a sick feeling in the pit of my stomach. I knew she was having a seizure. The following day, I contacted her neurologist and she scheduled an EEG. The episodes started happening more often. When she had the EEG done, it confirmed that the episodes were indeed seizures. We tried one medication and it didn’t work. Over the next 2 years we tried a second and then a third. They weren’t working.

The Ketogenic Diet

When Leah’s seizures started, she began to develop problems with eating and drinking. We noticed that the periods of time when she wasn’t eating and drinking much at all, her seizures lessened. I mentioned that to Leah’s pediatrician and she said she wondered if the ketogenic diet would work for her. I didn’t know a lot about it. I had some friends I met in the Infantile Spasms Community Facebook group that had children that were on or tried keto. Some had success and others didn’t. At our next neurology appointment, I mentioned it to the neurologist and she agreed that the ketogenic diet was our next option.

After we decided to try the ketogenic diet, our neurologist had the nutritionist come meet with us to talk more about it. We discovered that Leah was malnourished and dehydrated because of not wanting to eat and drink. Our team decided that until we could get her healthy, we would not be able to start the ketogenic diet. They decided the best way to get her healthy was to have a feeding tube inserted. Leah had her feeding tube placed in August of 2011. She started gaining weight and looked so much better, but by that time she was having hundreds of seizures a day.

On November 1, 2011, Leah was admitted to Geisinger’s Janet Weis Children’s Hospital to start the ketogenic diet. We started out slowly by using her formula mixed with KetoCal® 4:1 powder. Then we kept adding more KetoCal® while decreasing the other formula until she was getting all KetoCal. We had some bumps along the road during the admission. Leah was having some low blood sugars and was vomiting. The neurologist and nutritionist worked together to find that KetoCal® 3:1 powder, which has a lower ketogenic ratio, was a better match for Leah. The lower ketogenic ratio kept both her blood sugars in range and her stomach tolerated it well. We were discharged and returned home where I monitored and charted seizures every day. I started noticing a decrease in seizures. They decreased more and more every day. On day 8, Leah didn’t have any seizures. It was the same on day 9 and 10 and 11. Eventually, we were able to successfully wean Leah off of the last seizure medication that she was on. Leah was doing very well. She was happy. She was healthy. She was interacting with family and friends. She was enjoying life. Leah remained seizure-free on the ketogenic diet for nearly 3 years.

Leah Today

Just a few days shy of Leah being on the ketogenic diet for 3 years, things changed. I got a call from Leah’s school nurse, who said that Leah was having some involuntary rhythmic movement. Unfortunately, 4 years later we’re still seeing it despite continuing the ketogenic diet and adding in many more medications.

Leah is now 13 years old. We have finally found a cause for her epilepsy. She has a spontaneous mutation of her ALG13 gene. It is a very rare mutation, but is now a known epilepsy gene. She is having many seizures a day. We recently had a discussion with her neurologist about what we do next. Part of our new plan is to gradually wean Leah off of the ketogenic diet. It kind of makes me feel bad, but I know we gave it our all. Keto has been a big part of our life for almost 7 years now and I will forever be thankful for those 3 wonderful years that the ketogenic diet and KetoCal allowed Leah to be Leah. To be happy, healthy, and learning new things.

Advice to Parents Considering the Ketogenic Diet

My advice to parents considering the ketogenic diet is to discuss it with your neurologist, and if recommended, try it. We were cautious when starting. We didn’t want to get our hopes up just to be let down. I said the day we started that we’ll hope for the best and pray it’s our miracle, and it was. After the first month, when you establish a routine and find your groove, it gets easier. We measured our KetoCal out ahead of time when we got our shipment. Then all we had to do was add water and mix it daily. The ketogenic diet is definitely worth a try. Just remember to take it one day at a time and keep your eye on the prize…seizure control!

~Krista

I was paid by Nutricia for my time to write this blog, however, my opinions are my own.

KetoCal is a medical food intended for individuals age 1 year and up, and is intended for use under medical supervision.

The ketogenic diet for epilepsy should be used under medical supervision.

Please note that this is one family’s report of their experience with the ketogenic diet and may not be the experience of others. Individual results will vary. Please discuss the potential benefits of the ketogenic diet with your healthcare provider.

Coco’s Ketogenic Diet Story

My sweet Coco just celebrated her 7th birthday! Coco loves being outdoors, swinging and listening to Taylor Swift.  She has the most infectious laugh and is always ready to say hi and make new friends! Coco has two older and two younger siblings that she loves to try to keep up with!

Infantile Spasms:

When Coco was just 4 months old she was diagnosed with Infantile Spasms, a rare and catastrophic form of epilepsy.  Our world was turned upside down with hundreds of seizures a day that left Coco weak and miserable. We had noticed something was different about Coco around three months old.  She wasn’t making noise, she slept often, and it seemed as though she suddenly couldn’t hear or see us.  One night she looked like she was startled by a toy. It happened again, and again and again.  I videoed and drove her to the nearest emergency room.  We were assured that her movements were “normal” infant jerks. It continued at home that night so we went to a hospital with a pediatric emergency room.  We were admitted for an EEG, MRI and several blood tests.  The neurologist diagnosed Coco with Infantile Spasms and explained to us that there was a high chance of severe developmental delay.  We were devastated.  We started a gold standard medication.  After two months, it wasn’t working so we tried another front line.  And then another.  None of them were working and Coco was having hundreds of seizures a day.

The Ketogenic Diet

After failing several medications, we traveled to Detroit when Coco was just ten months old to meet a neurologist specializing in Infantile Spasms. He suggested we try the ketogenic diet.  We had run out of options and were desperate to stop the seizures. I came home and called our local hospital and another hospital with a big keto program to get Coco started.  Both had extremely long wait lists and we knew waiting wasn’t an option.  The specialist in Detroit agreed to help us start the ketogenic diet and within a week we returned and were admitted to begin the diet.

We spent a week learning about our new life with breastfeeding, purees and keto.  Our dietitian was extremely supportive of me continuing to nurse so she came up with a “recipe” for us combining breast-feeding and other keto ingredients.  We also learned to mix purees with butter for meals.  The first few months on the diet were extremely difficult. It was a big adjustment to make all meals using a gram scale and being worried about every little thing including the shampoo Coco bathed with. We slowly started noticing a decrease in seizures and after six months of being on the diet, we had seizure control.  Once Coco’s seizures were under control, she started making progress, first learning to hold her head up without support and then sitting up!  The ketogenic diet was our miracle!

KetoCal®

As a toddler, Coco continued to struggle with purees and we had a hard time getting her to take in anything including water.  Our neurologist suggested trying the ready-to-feed KetoCal® 4:1 LQ Vanilla. It was life changing! It’s easy for “on the go” and for the past five years it’s been Coco’s primary feeding source.  We travel often and KetoCal 4:1 LQ is easy to pack and take anywhere!  Coco has been on the ketogenic diet for 6 years now and KetoCal has been an invaluable aide every step of the way.

The ketogenic diet has become second nature to our family.  We know exactly what Coco needs and what she can and can’t eat.  It’s sometimes a struggle explaining the diet to others and even though she can eat meals that have been measured and mixed correctly, it’s difficult to trust that she’ll eat everything correctly at school and summer camp.  KetoCal makes it worry free- we can send in her ready-to-feed KetoCal 4:1 LQ Vanilla and know that she’s getting the correct ratio and there’s no risk for error.

Coco’s Life Today

Coco had a tough battle the first months after her diagnosis and she is severely delayed.  She’s non-verbal but can show preferences toward certain things and is learning to communicate with noises and gestures. She’s non-ambulatory but we haven’t given up on trying to learn to walk!  She just finished first grade and can identify numbers 1-4 and some colors! We still don’t know what caused Coco’s Infantile Spasms, despite countless tests and traveling to see world-renowned specialists.  The ketogenic diet has given Coco a better quality of life and has been our saving grace!  We’ve tried weaning Coco from the diet a few times over the past few years and have been unsuccessful. We lose seizure control right away each time. We’re hopeful that one day she’ll be able to enjoy meals and treats with the rest of the family but for now we’re thankful the diet keeps the seizures at bay.

We were originally told we only had two or three years at most with Coco and here we just celebrated her 7th birthday!  I’m forever grateful for the specialist that led us to the ketogenic diet and for KetoCal for making our daily lives so much easier!

Advice for Other Parents

Lastly, my advice to any parents thinking of starting the ketogenic diet with their child: Make a six-month commitment and stick with it!  The diet can be a challenge but with tweaking and learning what works for your child, it’s worth it!

-Shelly

I was paid by Nutricia for my time to write this blog post, however, my opinions are my own.

KetoCal is a medical food intended for individuals age 1 year and up. It is intended for use under medical supervision. 

The ketogenic diet for epilepsy should be used under medical supervision. 

Please note that this is one family’s report of their experience with the ketogenic diet and may not be the experience of others. Individual results will vary. Please discuss the potential benefits of the ketogenic diet with your healthcare provider.

Back to School Tips for Families on the Ketogenic Diet

As your children head back to school, we hope you can use these tips by ketogenic dietitian Lindsey Thompson, MS, RD, CSP, LD. Thanks, Lindsey!

Starting the new school year can be a mix of emotions from both excitement to apprehension, especially for families with a child on the ketogenic diet. Here are some tips to help get you through these upcoming weeks as school approaches.

Meet with the teacher and staff at the school

It is important, particularly if your child will be at a new school this year, to make sure all of the staff members who are in contact with your child are aware of his or her special diet and restrictions. If your child has an Individualized Education Program (IEP), you likely already have a meeting scheduled. Be sure to discuss:

  • Dietary restrictions- Many parents I have worked with find it helpful to compare the ketogenic diet to a food allergy (“my son has an allergy to carbohydrates or sugar”). Although this is an oversimplification of the diet, sometimes using the comparison helps staff understand the scope of the ketogenic diet when applied to epilepsy management.
  • Classroom items to avoid – In addition to the dietary restrictions, make sure staff are aware that classroom items containing carbohydrates could be harmful for a child on the ketogenic diet to use (for example, modeling clay/play dough, which contains flour). I tell classroom staff that when in doubt, have the child wear gloves when using a product in question.
  • Parties & Special Events – It is also important to review with the teacher the schedule of class parties or events that may contain food. Have the teacher let you know in advance when there will be a party or food so that you can send an appropriate ketogenic alternative for your child.

Ease into the school routine

Switching from the summer schedule to school schedule can be stressful. Kids with epilepsy may especially need additional time to adjust their sleep schedules in preparation for school. Practice your family’s school routine a few weeks in advance, perhaps in preparation for a day at the zoo or another activity. Set the alarms, have your children get up and ready, and pack that keto lunch for your child. You may even practice getting to the bus stop or driving to school to estimate the correct time needed. Practicing beforehand will make the first day of school go more smoothly.

Meal prep

As any keto parent knows, meal prepping for the ketogenic diet is very time consuming. Schedule a day or time to prepare ketogenic meals and snacks for school ahead of time. Many parents like to choose a day when a spouse or other caregiver is available to help keep the kids occupied, like a weekend day.

Try to keep school lunches simple. If your child likes to drink KetoCal®, your school can provide a serving of KetoCal for the same cost as a school lunch, which may save you time in having to meal prep. See this link for more information about the KetoCal and National School Lunch Program: https://www.myketocal.com/schoollunch/.

Helpful supplies for school lunches

Supplies that are helpful on the ketogenic diet lunches include:

  • An insulated lunch bag with an ice pack (to keep cream and other fats cold)
  • Small containers for holding the smaller portions of food required on the ketogenic diet
  • Some families like a bento-style lunch box and kids find that can be fun as well

Having a child on the ketogenic diet is a lot of work and preparation, but it is worth the effort. All of you keto parents and caregivers are doing great! I hope these tips will help ease you and your child on the ketogenic diet into a safe and happy school year!

-Lindsey

I was paid by Nutricia for my time to write this post, however, my opinions are my own.

KetoCal is a trademark of SHS International LTD.

KetoCal is a medical food for use under medical supervision.