Alternatively, if simple calorie restriction is sufficient to prevent seizure activity in patients, why not decrease total caloric intake, and not bother with the high-fat KD? However, from yet another perspective, one could consider combining the KD and calorie restriction (as has been done in animal studies). In rats fed a calorie-restricted KD, Bough and colleagues (2003) demonstrated exhibited greater paired-pulse inhibition in the dentate gyrus, elevated maximal dentate activation threshold, and an absence of “spreading depression”-like events compared with ad libitum-fed controls. These results suggest that treatment with a calorie-restricted KD may produce both anticonvulsant and anti-epileptogenic effects.

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Given these findings, it is not surprising that investigators have studied the effects of dietary supplementation with PUFAs alone, to determine whether these substrates can render an anticonvulsant effect. Early case reports suggested that seizures might be better controlled with this approach (Schlanger et al., 2002). However, a recent randomized trial in adult patients with epilepsy failed to demonstrate superiority of a PUFA supplement (EPA) plus DHA, 2.2 mg/day in a 3:2 ratio) over placebo (Bromfield et al., 2008). Thus, the jury is still out as to whether PUFAs alone can mirror the clinical effects of the KD.

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