I have been a devoted reader since I first became a nurse practitioner in 2004. I felt compelled to write about the epilepsy CME article (“Paving the way to better epilepsy outcomes”) in the June 2017 issue.

Although Drs Joseph Sirven and Sheryl Haut covered the topic of improving seizure control, improving patient adherence (likely due to the difficulty to tolerate medications), and minimizing side effects, I was terribly disappointed to see nothing about diet covered in this comprehensive article. Your readers quite likely use the material you publish to enhance their practice, and we nurse practitioners are a rather holistic bunch.

It is well-documented in the literature that those with epilepsy benefit greatly from a ketogenic diet, especially children. Often, medications are not even needed in a lot of cases. The ketogenic diet is—and remains—the only treatment with the consistent ability to prevent seizures, as ketogenic diets just work! The diet increases the conversion of glutamate into glutamine into GABA, reducing neuronal excitability. It increases antioxidant status in the neuronal mitochondria, improving their function. It also reduces free radical formation in neurons, a likely cause of seizures.

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The following are links to recent studies on the subject: 

  • http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001903.pub2/full
  • http://www.sciencedirect.com/science/article/pii/S0920121112000502
  • http://www.sciencedirect.com/science/article/pii/S1059131110001202
  • https://www.ncbi.nlm.nih.gov/pubmed/27249895
  • https://www.ncbi.nlm.nih.gov/pubmed/25457511
  • https://www.readbyqxmd.com/read/28179470/phase-i-ii-multicenter-ketogenic-diet-study-for-adult-superrefractory-status-epilepticus

I am sure that Drs Sirven and Haut are great doctors, but they seem to focus only on conventional medicine and heavy use of pharmaceuticals, which only treats the symptoms of the disease. I practice functional medicine, which tries to get to the cause of the disease, treating the actual disease itself. Although I practice in diabetes, I am an expert in the Paleo diet, which can often be ketogenic. — Chrystyne Olivieri, DNP, FNP-BC, CDE, Greenlawn, NY

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