Marked Seizure Reduction after MCT Supplementation

We report the case of a 43-year-old man with history of nonsurgical partial epilepsy who previously failed multiple trials of antiepileptic drugs. Medium-chain triglycerides (MCT) were added to his regular diet in the form of pure oil. Subsequently, his seizure frequency was markedly reduced from multiple daily seizures to one seizure every four days. His seizures recurred after transient discontinuation of MCT over a period of ten days. His seizure improvement was achieved at a dose of four tablespoons of MCT twice daily with no reported side effects. He developed significant diarrhea and flatulence at higher doses. We conclude that MCT oil supplementation to regular diet may provide better seizure control in some patients. MCT oil supplementation may be a more tolerable alternative to the standard ketogenic diet. 1. Introduction The ketogenic diet was proven to be effective in treating patients with drug-resistant epilepsy. However, its sustained efficacy requires strict adherence to a high fat diet that can limit patient compliance. The fat intake can be derived either from long- or medium-chain triglycerides (MCT) [1]. One major component of MCT is caprylic acid which was recently FDA approved as a food supplement for the symptomatic treatment of Alzheimer’s disease [2]. While maintaining a regular diet, MCT supplementation demonstrated increased ketosis, suggesting a possible role in the treatment of epilepsy. In this case, we report a patient with drug-resistant epilepsy who experienced marked seizure reduction after the addition of MCT oil to his regular diet. 2. Case A 43-year-old Caucasian right-handed man presented to our clinic with longstanding history of drug-resistant partial epilepsy. His first seizure occurred at the age of five years. Since then, he was treated with multiple antiepileptic drugs resulting only in short periods of seizure freedom. He reported daily seizures averaging six per day, in spite of an adequate dosage of levetiracetam, lamotrigine, and phenytoin. He described stereotypical episodes of an initial “closing-in” sensation followed by a variable degree of loss of awareness or staring as reported by his wife. His seizures rarely progressed into secondarily generalized tonic-clonic seizures. His seizure risk factors included a history of premature birth and a paternal uncle with epilepsy. His past medical history included gastroesophageal reflux disease treated with famotidine. His general and neurological examinations were normal. As part of a presurgical evaluation, a five-day inpatient video-EEG study recorded 12