Medicine (RMH) - Theses
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ItemDietary Therapies For Adults With Epilepsy( 2022)Epilepsy is a chronic neurological condition, characterised by recurrent, spontaneous seizures. For the majority of people with epilepsy, their seizures will be controlled by anti-seizure medications. However, one-third of people with epilepsy will not have their seizures controlled, and in these patients with drug-resistant epilepsy, alternatives to medications should be considered. Ketogenic diet therapy is well-established in paediatric epilepsy care, however it has not been widely translated into adult practice. This thesis focuses on the feasibility, safety and efficacy of novel diets and dietary supplements as potential treatments for adults living with epilepsy in Australia, and emerging evidence for this approach as an adjunct treatment for super-refractory status epilepticus. The first aim of this thesis was to determine the feasibility and efficacy of novel dietary therapies for adults with drug-resistant epilepsy. To address this aim, we first conducted a 12-week randomised-controlled trial and 12-month open label extension study of oral triheptanoin oil as an add-on treatment for adults with drug-resistant epilepsy. Next, we investigated the feasibility and efficacy of the modified Atkins diet for epilepsy in adults in a 12-week randomised-controlled trial. Finally, we conducted a prospective audit of a newly established dietary therapy for epilepsy service embedded in a quaternary teaching hospital. The findings of these trials highlight challenges of conducting clinical trials of dietary therapy for epilepsy in adults, such as adherence and high attrition rate. We observed some adults with drug-resistant epilepsy may benefit from dietary therapy, with few serious adverse effects associated with its use. The second aim of this thesis was to investigate the emerging role of dietary therapy as treatment for super-refractory status epilepticus in adults. A review of the literature found a small number of retrospective, observational studies reporting use of the classical 4:1 ratio ketogenic therapy in this setting. We then conducted a retrospective cohort study at two quaternary teaching hospitals of patients treated with a 2:1 ratio ketogenic therapy for super-refractory status epilepticus. This lower ratio ketogenic therapy may be associated with fewer complications and better align with current critical care nutrition guidelines. The development and implementation of non-drug treatment options for epilepsy is crucial in the context of a multifaceted approach to improving seizure control and reducing disease burden. The research in this thesis demonstrated the safety, acceptability, practicality, and efficacy of dietary approaches as adjunct therapies for patients with drug-resistant epilepsy as an outpatient, and for critical care inpatients with super-refractory status epilepticus. There remains a significant need for ongoing research focusing on optimal dietary regimens and strategies to increase patient retention of dietary therapy long term for adults with epilepsy.