When Cadence Rohrbaugh sent out invitations to her high school graduation party earlier this year, she tucked personal notes into a few special envelopes.

"Dear Dr. Wirrell," Cadence wrote in one. "Thank you so much for helping me and my family through one of the most difficult times ever. Without your care, I would not be alive, healthy and graduating with honors."

Fifteen years earlier, Elaine Wirrell, M.D., had been part of a team that cared for Cadence after she developed epilepsy.

"I wasn't expecting Dr. Wirrell or my other caretakers to come because they are so busy," Cadence says. "But I wanted to let them know about this huge milestone in my life and to thank them for their care."

So even though Cadence had sent the invitation, it still surprised her to see Dr. Wirrell walking up her driveway and back into her life.

"When I saw Dr. Wirrell, it was pure shock," Cadence says. "It was incredible."

A devastating — and familiar — diagnosis

When she first met Dr. Wirrell, director of Pediatric Epilepsy at Mayo Clinic, Cadence was a cheerful, chatty 3-year-old who had begun having seizures. It was a terrifying time for Cadence's parents, especially her mother, Laura Rohrbaugh.

"I have epilepsy," says Laura. "I've been seizure-free since 1990, but I know what a devastating diagnosis it is."

That's why when she and her husband, Richard Rohrbaugh, were completing adoption paperwork, they indicated that they were open to adopting a child with any medical condition, except one.

"I know how terrible epilepsy is, how isolating," Laura says. "I didn't think I could watch a child go through that. But we're believers, and we have faith things happen for a reason."

After Cadence's first seizure, Dr. Wirrell recommended taking a wait-and-see approach before beginning treatment.

"We were told there was a 50-50 chance she'd have another seizure," Laura says. "And at first, nothing happened. It seemed like she'd be fine."

But two months later, Cadence had another seizure. And another. Soon, up to 12 a day.

Cadence was admitted to Mayo Clinic Children's Center and began electroencephalography, or EEG, testing. She also had numerous lab tests, an MRI and a spinal tap before doctors arrived at a diagnosis of myoclonic-atonic epilepsy, also known as Doose syndrome. The rare condition accounts for just 1–2% of childhood epilepsy diagnoses.

"It was evident early on that her seizures were bad," Laura says. "It took only 10 days for her to stop walking, talking or feeding herself. She'd always sucked her fingers for comfort, and she wasn't even able to lift her fingers to her mouth."

Dr. Wirrell prescribed various medications to try to control the seizures. Cadence also had intravenous immunoglobulin treatment that is aimed at normalizing the immune system. Still, the seizures kept coming. That's when Laura asked Dr. Wirrell a question.

"I said, 'Mom to mom, what would you do if this was your child?'" Laura says.

Dr. Wirrell's answer was life-changing for the Rohrbaugh family: "I'd put her on the ketogenic diet."

Life-changing, lifesaving diet

The ketogenic diet, first described at Mayo Clinic in the 1920s, is an extremely high-fat, low-carb diet that causes the body to burn fat instead of carbohydrates. This causes the body to produce chemicals called ketones and go into a state called ketosis. In some people with epilepsy, this state can reduce or eliminate seizures.

"A lot of people hear ketogenic diet and think Atkins diet," Laura says. "But this is totally different."

The diet requires eating precise amounts of food in specific ratios. Everything Cadence ate needed to be weighed or measured, and she needed to clean her plate at every meal. Even her shampoo, sunscreen and soaps — anything that could be absorbed through her skin — had to be keto-compliant.

"The ketogenic diet can be quite time-consuming for families to prepare and follow," Dr. Wirrell says. "When I mentioned this to Cadence's family, their only question was, 'How soon can we start?'"

Laura admits the diet was difficult at first. But the challenge was more than worth it. Within a month of beginning the diet, Cadence was seizure-free.

"We got our girl back," Laura says.

After four years on the ketogenic diet and various medications, Cadence was slowly weaned from both.

"By the time she was 7, Cadence was completely off all medications and the ketogenic diet. And she still remained seizure-free," Laura says. "When she was 8, she was pronounced cured of epilepsy."

Happy tears

Now 18, Cadence remembers very little about her time in the hospital or on the ketogenic diet. But childhood photos and conversations with her parents have helped her understand the important role people like Dr. Wirrell played in her life.

"I was so happy to reconnect with her at my graduation party and tell her all the amazing things I've been able to do because of her," Cadence says.

Things like graduating with honors from John Marshall High School. Serving as drumline captain her senior year. Heading off to South Dakota State University to start the next chapter in her life story.

"It was incredible to look at the photo gallery Cadence's mom and dad had put together and see all that she had done," Dr. Wirrell says. "It was pretty special to connect with the family and nice to share happy tears this time. We are often with families at difficult times, and it is heartwarming to also be included in the celebrations."

It was heartwarming for Laura, too.

"It was incredibly emotional to see Dr. Wirrell again," Laura says. "We were crying, laughing, hugging. What a blessing it was to thank her in person for the gift she gave our family."

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THIS WEEK'S TOP TOPICS
Insect bites and stings: First aid 
Most reactions to insect bites and stings are mild, causing little more than redness, itching, stinging or minor swelling. Rarely, insect bites and stings, such as from a bee, wasp, hornet, fire ant or scorpion, can result in severe reactions. Some insects also carry disease, such as West Nile virus. Learn how to take care of an insect bite or sting that causes a mild reaction, and when you need to seek emergency medical care.

The truth behind the most popular diet trends of the moment
With so many competing and often contradictory diet trends, finding a healthy eating plan that works for you can be confusing. Is skipping meals a bad idea or a secret weight-loss weapon? Should you eat a low-fat or high-fat diet? You probably could eat less added sugar, but should you eliminate it completely? Compare and contrast four popular eating styles — Whole30, the ketogenic diet, the anti-inflammatory diet and intermittent fasting — and see if one might be right for you.

EXPERT ANSWERS
Can a Mediterranean diet lower Alzheimer's risk?
A Mediterranean diet — one rich in fruits, vegetables, olive oil, legumes, whole grains and fish — offers many heart-healthy benefits. But a Mediterranean diet also may benefit your brain. Learn more from Dr. Jonathan Graff-Radford, a Mayo Clinic neurologist.

Strength training sets: How many for best results?
Are you considering adding strength training to your workouts? For most people, a single set of 12 to 15 repetitions with the proper weight can build strength and improve fitness as effectively as can multiple sets of the same exercise. Learn more from Dr. Edward Laskowski, a Mayo Clinic physical medicine and rehabilitation specialist and co-director of the Mayo Clinic Sports Medicine Center.

PLUS ADDITIONAL HIGHLIGHTS
Brain aneurysm
Nearsightedness
Canker sore
Liposuction

HEALTHY RECIPES
English cucumber salad with balsamic vinaigrette
Crabcakes
Creamy asparagus soup
Barley and roasted tomato risotto

HEALTH TIP OF THE WEEK
Protein: Heart-healthy sources
Does your diet include unhealthy sources of protein — perhaps burgers, hot dogs and fried chicken — in excess? Do your heart a favor and choose your proteins wisely. Legumes — beans, peas and lentils — are a great source of heart-healthy protein. Legumes are typically low in fat and contain no cholesterol. Legumes also contain soluble and insoluble fiber.

Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org. 

Receive a free e-subscription to Housecall and other health newsletters.

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On the next Mayo Clinic Radio program, Katherine Zeratsky, a Mayo Clinic registered dietician nutritionist, will discuss the keto diet and compare it with other popular diet plans, including the Mediterranean diet; Dietary Approaches to Stop Hypertension, also known as the "DASH diet"; and the Mayo Clinic diet. Also on the program, Dr. Tobias Kohler, a Mayo Clinic urologist, will explain why vasectomy rates rise in March. And Dr. Jan Buckner, chair of Oncology at Mayo Clinic's Rochester, Minnesota, campus, will discuss why deaths from cancer in the U.S. continue a 25-year decline.

To hear the program, find an affiliate in your area.

Miss the show? Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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"People want to believe," says Dr. Donald Hensrud, author of The Mayo Clinic Diet Book. "They want an easy way out. They want the magic panacea."

But Dr. Hensrud says the keto diet isn't new, and it's not the magic formula people think it is.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads at the end of the post.
Please ‘Courtesy: Mayo Clinic News Network.’ Read the script.

"We've known for a long period of time that when you decrease carbohydrate intake markedly, the body starts to use fat," Dr. Hensrud says. "And when you burn fat, you produce ketones, and the body goes into ketosis."

He says it will help you drop weight. The problem is what happens after most people lose the initial weight.

"Long term, it's hard," Dr. Hensrud says. "People miss some fruits, different vegetables, grains. It's hard. It becomes a very restrictive diet. So although people lose weight initially, maintaining it and keep it off long term is a real challenge on a keto diet."

Instead, Dr. Hensrud recommends focusing on a healthier lifestyle with exercise; portion control; and a diet with more fruits, vegetables and whole grains. You might not lose weight quite as quickly, but it will be healthier for your body long term.

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Watch: What to know about the ketogenic diet for epilepsy.

Journalists: Broadcast-quality video (1:34) is in the downloads.

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Their emotion and surprise was to be expected. By the time the little girl was 4 years old, she had only ever said one complete sentence, words from a song called "Good Morning Beautiful."

The story of Christina's amazing achievement starts when she was an infant, living in Texas. At 7 months old, Christina had a seizure. Other seizures followed, and they never stopped. Christina's physicians could not find a cause of the seizures.

"With seizures that were strong and difficult to control, Christina was on the critical end of seizure disorder, or epilepsy, without relief. Our lives had become one long seizure," her mother says. "She was nonfunctional in cognitive ability and development. I could not leave Christina alone for a moment. Her crib was padded, but she would thrash around when she had a seizure and could get hurt. The condition was very confining for our family. We took her to Mayo Clinic for the first time when she was 1 year old. Right away, they found a lesion in her right temporal lobe that could be the cause of her seizures."

For the next year and a half, the family went back and forth between Texas and Minnesota for Christina's care. The Georges learned about the ketogenic diet, a specialized high-fat diet, developed at Mayo Clinic in 1921 to treat seizures. Together they worked with Christina's physicians and a dietitian to manage the diet.

"The ketogenic diet provided relief from seizures, but it is so intricate that I couldn't leave her with anyone else," says George. "The nurses and physicians at Mayo Clinic knew how to care for Christina. That was obvious from her first hospital stay there. Her room was all prepared for her with a padded crib and a supply of emergency medicine. The nurses knew the protocol for the ketogenic diet and made sure that anyone who provided care for Christina knew it as well."

The family decided to move to Wisconsin in mid-1999. "We needed to be closer to Mayo Clinic, to be near people who knew how to treat Christina's condition," says George. "My husband found a job in Wisconsin so we could be within a day's drive of Mayo Clinic. Within a few months, Christina's seizures stopped. I credit prayer and the ketogenic diet for that first miracle."

Two years later, Christina's physicians recommended slowly removing her from the ketogenic diet, which most children are on only two or three years. Within a week of reducing the diet, Christina's seizures returned. Her breathing began to stop during the seizures. Medication options had been exhausted.

Christina's team of physicians recommended surgery to remove the complete right temporal lobe of Christina's brain. The girl hadn't initially been a candidate for the surgery because her seizures had involved her entire brain. But after having been on the ketogenic diet and seizure-free for two years, Christina's seizure activity was localized in the area of a lesion in her right temporal lobe. Surgery had become an option.

Her parents needed a little time to adjust to the idea of having so much of Christina's brain removed.

"We were reluctant at first, but something had to be done because the seizures were even more serious now, with her breathing stopping," says George. "We decided it was Christina's only chance to have a life without seizures."

Christina had the surgery in December 2001 when she was 4 years old. She had her last seizure a few days later, on Christmas Day.

"When she awoke from surgery, I could tell she was different - that the part that caused the seizures was gone," says George. "She saw her dad standing at the end of her hospital bed and said, 'Papa, my daddy.' We were so happy that her memory was intact and that she could think and speak. I had always wanted Christina to be able to talk to me and tell me what she was thinking."

Within months after surgery, Christina was talking and playing normally with toys for the first time in her life. Today, she jumps, runs, roller skates, reads, adds numbers and argues with her brother about whose turn it is to use the computer.

"Surgery was a scary thing but the miracle Christina needed to go forth and grow. She shows us every day more and more things she can do," says her mother. "We can't thank God or Mayo Clinic enough. The doctors and nurses took care of our daughter when we couldn't. We worked together to get Christina better."

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"When she had to take anti-seizure medication, we could always get her to take it if we mixed it in mashed potatoes," says her mother, Mary. "Shelby loved mashed potatoes. It would be too cruel for the rest of us to eat them, knowing Shelby couldn't have them too."

Shelby has been on the ketogenic diet, drug-free — and seizure-free -- for several months. Her father, Kelly, learned about the diet on the Internet. Shelby's local physician referred the family to the Pediatric Epilepsy Program at Mayo Clinic in Rochester for help administering the diet. Close collaboration with an experienced dietitian knowledgeable about the diet is essential. Under the supervision of a physician, the dietitian works closely with the patient's family to carefully control the diet. For reasons unknown, the diet inhibits seizures, primarily in childhood epilepsy.

Shelby tried several anti-seizure medications in the six months after her seizures began, but none succeeded in controlling her two dozen daily seizures.

"My two oldest daughters, Allie, 15, and April, 13, and I followed Shelby around like a shadow so she wouldn't hit the floor when she had drop seizures," says Mary.

Shelby has atonic epilepsy, which causes momentary loss of muscle control and dropping to the floor.

"It seemed as if Shelby had a string attached to her head that would suddenly pull her head to the floor," says Mary. "It was traumatic for our family. The two older girls were afraid Shelby would die. We stopped going to restaurants. Shelby's development seemed to stop when her seizures began.

"I was reluctant to try the ketogenic diet, but my husband said we didn't have anything to lose," says Mary. "I agreed to try it. I'm so glad I did. What this diet did for our family is miraculous. We can go to restaurants now. We take special food for Shelby. We see signs of Shelby's personality emerge now. She smiles and giggles and wants to play."

Shelby's carefully controlled diet includes scrambled eggs, vegetables, butter, heavy whipping cream, skinless chicken breasts, t-bone and sirloin steak. Mary consults a dietitian at Mayo Clinic for new recipes and advice.

"I called the dietitian at home one night because Shelby had a fever. Children's Tylenol contains sugar, which Shelby cannot have," says Mary. "I needed to know what I could give her. The dietitian checked and told me Shelby could have adult Tylenol but to consult our pediatrician for the correct dosage, based on Shelby's age and weight. Mayo Clinic has been such a godsend for us."

The Birch family hopes Shelby can be weaned off the diet in a couple of years and remain seizure-free. In the meantime, the family continues its vigilance at protecting Shelby from the many foods not allowed in her diet.

"Our 4-year-old daughter, Libby, is very protective of Shelby," says Mary. "She found Shelby with a package of crackers and screamed like another child might if a baby had a sharp knife. For the time being, our family and friends know the importance of keeping Shelby from the foods that will cause her seizures to return. They see how dramatically our life has changed since Shelby began this diet. The least we can do is not eat mashed potatoes."

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Larry and Paulette George had never seen a seizure before when their 7 month old daughter, Christina, began having more than 100 seizures a day. They tried medication after medication, but the seizures wouldn't stop.

Paulette's sister had heard something about a diet for seizures and mentioned it to them, but when they asked their physician, they were told that it was unsafe. Paulette and Larry were desperate to help Christina and after learning that the ketogenic diet was developed at Mayo Clinic, they flew 1,200 miles from their home in Texas to Mayo Clinic in Minnesota, seeking answers and hope. They eventually moved to Wisconsin to be only a day's drive from Mayo Clinic.

At 2 1/2 years old, Christina was autistic and didn't speak. The ketogenic diet stopped the seizures and paved the way for her to have brain surgery at Mayo Clinic. She has not had a seizure since 2001. Today, Christina is a beautiful, healthy, smart and active 12 year old.

Here's a video of Paulette describing their journey:

Paulette is passionate about sharing Christina's story in order to help other families dealing with seizures and increase the awareness of the ketogenic diet. She recently released a book about their journey entitled, Good Morning, Beautiful: Winning the Battle Over Seizures. The book's title refers to the song by Steve Holy -- Christina sang the words to the chorus of that song as some of her very first words after the ketogenic diet had stopped her seizures.

Paulette will be at the Barnes & Noble near the Mayo Clinic campus in downtown Rochester, Minn. for a book signing from 11 a.m. to 2 p.m. on Tuesday, June 22. More information is available at http://www.paulettegeorge.net.

Related Diseases

• Epilepsy
  

Related Treatments

• Brain surgery
• Ketogenic Diet

Related Departments

• Neurology and Neurosurgery

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