A randomised trial of a medium-chain TAG diet as treatment for dogs with idiopathic epilepsy

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 (0·041 (sd 0·004) v. 0·031 (sd 0·016) 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.

Dietary intervention for canine epilepsy: Two case reports

“…It was not a "ketogenic" diet, and thus may be less effective for some dogs than it was for Case 2. [13][14][15] The need for alternatives to current AEDs in dogs is underscored by their lack of efficacy in some cases and harmful side effects in others, 4 including-as detailed in Case 1's report-liver damage from prolonged use of phenobarbital. Anecdotally, Case 1's owners also reported that while in the process of researching his condition and customizing his diet, ingestion of a nonketogenic treat seemed to trigger a seizure event.…”

“…11 However, relatively few modern dogs subsist primarily on raw meat or even any raw meat, and no scientific data has yet to confirm its benefits in controlling epilepsy in canines. 13 This KMCT diet also reduced a subset of attention-deficit/hyperactivity disorder-like features noted in the dogs with epilepsy, including chasing and strangerdirected fear. 2 Clearly, laboratory-based rats and mice have significant advantages (ie, limited variability, environmental control, opportunities for genetic modification, rapid growth and reproduction, and relatively low cost).…”

“…10 Therefore, a diet consisting mainly of raw meats has had anecdotal success based on the theory that dietary deficiencies and grains in commercial product can cause or trigger epileptic seizures. One study of 21 dogs found that seizures were reduced significantly in dogs fed a proprietary ketogenic MCT (KMCT) diet for 3 months 13,14 whereas no improvement was seen in dogs fed a standard diet for the same duration. Furthermore, although most neuroscience research in mammals is conducted in rodents, canines provide different opportunities due to the natural occurrence of epilepsy.…”

“…1,12 To date, a compelling body of controlled studies regarding diet-based therapies for dogs with seizures remains limited. One study of 21 dogs found that seizures were reduced significantly in dogs fed a proprietary ketogenic MCT (KMCT) diet for 3 months 13,14 whereas no improvement was seen in dogs fed a standard diet for the same duration. For 3 subjects, seizures appeared to stop entirely, demonstrating a 100% reduction in seizure frequency.…”

2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs

“…The study failed to identify a difference in seizure frequency between the groups and 3 of 9 dogs fed the ketogenic diet developed pancreatitis. In contrast, a medium chain triglyceride (MCT)‐based diet developed for the treatment of cognitive dysfunction in dogs111 was evaluated in dogs with idiopathic epilepsyin, a 6‐month prospective, randomized, double‐blinded, placebo‐controlled crossover dietary trial 112. Seizure frequency and monthly seizure days were significantly lower in the 21 dogs finishing the trial when on the test diet for 12 weeks as compared to those on the placebo diet.…”