Abstract
Despite appropriate antiepileptic drug treatment, approximately one-third of humans and dogs with epilepsy continue experiencing seizures, emphasising the importance for new treatment strategies to improve the quality of life of people or dogs with epilepsy. A 6-month prospective, randomised, double-blinded, placebo-controlled cross-over dietary trial was designed to compare a ketogenic medium-chain TAG diet (MCTD) with a standardised placebo diet in chronically antiepileptic drug-treated dogs with idiopathic epilepsy. Dogs were fed either MCTD or placebo diet for 3 months followed by a subsequent respective switch of diet for a further 3 months. Seizure frequency, clinical and laboratory data were collected and evaluated for twenty-one dogs completing the study. Seizure frequency was significantly lower when dogs were fed the MCTD (2·31/month, 0-9·89/month) in comparison with the placebo diet (2·67/month, 0·33-22·92/month, P=0·020); three dogs achieved seizure freedom, seven additional dogs had ≥50 % reduction in seizure frequency, five had an overall <50 % reduction in seizures (38·87 %, 35·68-43·27 %) and six showed no response. Seizure day frequency were also significantly lower when dogs were fed the MCTD (1·63/month, 0-7·58/month) in comparison with the placebo diet (1·69/month, 0·33-13·82/month, P=0·022). Consumption of the MCTD also resulted in significant elevation of blood β-hydroxybutyrate concentrations in comparison with placebo diet (0·071 (sd 0·035) v. 0·053 (sd 0·028) mmol/l, P=0·028). There were no significant changes in serum concentrations of glucose (P=0·903), phenobarbital (P=0·422), potassium bromide (P=0·404) and weight (P=0·300) between diet groups. In conclusion, the data show antiepileptic properties associated with ketogenic diets and provide evidence for the efficacy of the MCTD used in this study as a therapeutic option for epilepsy treatment.
Highlights
Epilepsy is a common chronic neurological disorder in humans and dogs, with an estimated prevalence in dogs of 1–2 %(1) in a referral hospital population and 0·6 %(2) in first-opinion practice
The primary focus of this study was to evaluate the antiepileptic efficacy and tolerability of a low medium-chain TAG (MCT)-containing diet to dogs with idiopathic epilepsy chronically treated with standard antiepileptic drugs (AED)
Twenty-one dogs with epilepsy were enroled into a 6-month prospective study, in which they were separately fed the medium-chain TAG diet (MCTD) containing low concentrations of MCT (5·5 % as fed) for 3 months and an isoenergetic placebo diet containing the same levels of fat, protein and carbohydrate for 3 months
Summary
Epilepsy is a common chronic neurological disorder in humans and dogs, with an estimated prevalence in dogs of 1–2 %(1) in a referral hospital population and 0·6 %(2) in first-opinion practice. AED-related side-effects such as ataxia, polyphagia, polyuria, polydipsia and incontinence in dogs as well as behavioural, sedative, cognitive or psychiatric adverse reactions in humans contribute to reduction in QoL[12,13]. This emphasises the importance of new treatment strategies to improve the welfare of people with epilepsy. Due to the antiepileptic effectiveness observed in the ‘classic’ KD[19,20,21,22], other KD, some with improved palatability and diet toleration, have been proposed These include the modified Atkins diet[23], medium-chain TAG ketogenic diet (MCTKD)(24,25), low-glycaemic-index treatment[26] and diets that involve intermittent energitic restriction[27]. Such MCTKD diets, containing high proportions of dietary fats, have still been perceived as problematic due to palatability and diet restrictiveness
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