How a modified Atkins diet saved a 12-year-old from life-threatening epilepsy

Jash was rushed to the emergency ward of Fortis Hospital, Mulund on January 9 as he was suffering from a complex Super-Refractory Status Epilepticus (SRSE) — a neurological emergency with high morbidity and mortality. In this condition, the seizures continue or recur for 24 hours or more even after the onset of anaesthetic therapy. This is an uncommon scenario and its incidence is very low, around 0.7 per million. Jash happened to be one of the patients with this rare affliction.

He was immediately intubated and ventilated and put under the care of the paediatric intensive care team for about two weeks. The primary treatment was aimed at stopping his seizures in order to avoid cerebral damage and other morbidity. But even after two anaesthetics and five seizure medications, Jash was in a state of tonic seizures that led to stiffness in the muscles of his arms, legs and torso. That’s when Dr Rima Chaudhari, senior consultant, neurologist and epileptologist, decided to put Jash on the Modified Atkins Diet. In simple terms, it is high in fat, adequate in protein and very low in carbohydrates.

Dr Chaudhari explained that such a diet produces ketones when the body uses fat as fuel instead of carbohydrates. These can prevent seizures. “When the brain cells get excited and release a large amount of excitatory neurotransmitters, the message continues to be passed along to the next cell, the networks of neurons continue firing up when they are not supposed to. The inhibitory neurotransmitters like gamma-aminobutyric acid, or GABA, fail to suppress the spread. That’s when Modified Atkins Diet helps as studies have shown that it reduces such body responses and ensures a better synthesis of GABA,” she said. “The keto diet has been recommended for the treatment of status epilepticus. However, in this case we used a variant of the keto diet or Modified Atkins, which is less restrictive (in terms of percentage of fat). It met the nutritional needs of this child who was in the ICU for a long time, which was also a point of concern, but importantly, it relieved him from seizures.”

Minal Shah, Chief Nutrition Therapist of the hospital, administered the diet through a feeding tube. She also monitored ketones in the urine continuously to modify the patient’s diet plan as per his body’s response. Jash’s condition started improving from the second day of the modified diet. When he was able to have the food orally, his diet included a combination of vegetables and fats. The food was prepared using paneer, vegetables, cauliflower rice, soya and oil. Coconut barfi and fried peanuts were also served as mid-meal snacks. As the food was heavy on fat, it was challenging for the team to make the patient consume it. Therefore, it was served in a visually appealing and palatable way. Every meal was meticulously cooked in the kitchen, with careful measurement of every ingredient, and preparation under the direct supervision of the dietitian. He was not allowed to have any kind of sugar or processed food and the diet included a combination of vegetables and fats.

Even now, Jash is on a Modified Atkins Diet, his recipe for life. As his father, Chirag Haria, said, “Just to check if he does well without the diet, we changed it slightly. He immediately had a seizure. This clearly showed how the diet saved my son’s life.”