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Study Suggests Epilepsy Diet Still Effective

November 16, 1998|THOMAS H. MAUGH III

Physicians are often like home technophiles--seduced by the new to the detriment of the old. Just as a technophile replaces his perfectly usable records with CDs, physicians often turn to the latest therapy, ignoring older ones that may have equal value.

Epilepsy treatment provides a good example. One of the earliest treatments for this disease was the ketogenic diet, a rigorously controlled high-fat, low-protein, low-carbohydrate diet that mimics the biochemical changes associated with starvation.

The diet was widely used until 1938, when the advent of diphenylhydantoin made drug treatment of epilepsy practical. As more new anticonvulsants appeared, the diet was used less frequently, and many doctors accepted the growing belief that it did not work and was difficult to tolerate.

A new study in Thursday's Archives of Neurology, however, indicates that the ketogenic diet can be a valuable treatment for patients who do not respond to drugs.

A multicenter team studied 51 children, 1 to 8 years old, who suffered more than 10 seizures a week and who had failed on at least two other drugs. The children were hospitalized, then they fasted before going on a ketogenic diet.

At the end of three months, more than half of the children who remained on the diet had at least 50% fewer seizures. After a full year, 40% of those who started the diet had at least a 50% decrease in seizures, and five patients were totally free of seizures.

In this case, at least, an alternative medicine treatment seems to be a valuable complement to conventional therapy.

New Type of Painkillers Seems to Cut Ulcer Risk

Aspirin, Tylenol, ibuprofen and other over-the-counter analgesics are useful for combating minor aches and pains. But of the 13 million people who use these medications each year, 76,000 are hospitalized for ulcers caused by the drugs, and about 7,600 of them die from the drugs' effects.

Last week, however, two companies reported the first experimental results with painkillers from a new class of drugs called cox-2 inhibitors. Low doses of these drugs seemed to be as powerful as the aspirin and ibuprofen category of medications--the nonsteroidal anti-inflammatory drugs, or NSAIDS. But the cox-2 inhibitors did not produce the disastrous gastrointestinal side effects.

Researchers from G.D. Searle of Skokie, Ill., for example, presented results from a 12-week study of 1,004 osteoarthritis patients who took either the Searle drug celecoxib, the NSAID naproxen or a placebo. Celecoxib was as effective as naproxen at relieving pain and stiffness, but those taking it had no more gastrointestinal side effects than those taking the placebo.

The Food and Drug Administration may decide next month whether the drug can be approved for treatment of osteoarthritis.

Researchers Differ on Fen-Phen Fallout

Local researchers presented conflicting findings last week on the aftermath of the fen-phen diet debacle at the American Heart Assn. meeting in Dallas. Redux, the "fen" part of the widely used diet combo, was pulled from the market in September 1997 after researchers discovered heart valve defects in some patients taking the drugs.

The debate has special resonance in Los Angeles, where more prescriptions for the drug were written than in any other city in the world, says Dr. Bruce Samuels of the Heart Center of Los Angeles.

A key question is how many patients actually suffered long-term damage. Samuels studied 89 patients and found that 29% of them had significant valve leakage. "Significant" is a term used by the FDA to define an abnormality in the valve, but it does not necessarily imply actual damage to the patient's health. Between 3% and 5% of the population who have not taken diet drugs have such abnormalities.

Samuels reported that those who took the largest amounts of the drug for the longest times were at the greatest risk. Of those who were on the drug more than nine months, 37% had significant leakage.

In contrast, Dr. Julius M. Gardin of the UC Irvine College of Medicine reported on 455 patients who took the combo for at least a month. Among those taking it for at least three months, 14.9% had significant valve leakage. Gardin's study was sponsored by Wyeth-Ayerst, which manufactured the drug.

Samuels' patients may have done worse because they were on the drugs longer and were thinner to begin with, he said. He fears that some of those patients may suffer long-term heart damage, but "I hope to God I am wrong," he concluded.

Drug Reduces Fractures Due to Steroid Therapy

A new drug called risedronate can reduce fractures in the vertebrae among patients who are taking long-term steroid therapy to treat rheumatoid arthritis, Crohn's disease and lupus. Prolonged steroid treatment can cause patients' bones to thin.

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