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The second step in the process of evaluating your child for surgery should take place in an epilepsy center capable of carrying out the full evaluation and the surgery.

If the center does not know your child, they will want to review his records carefully and may want to repeat EEGs and scans before deciding if further evaluation is in order. The center might also think that further trials of medication might be useful before considering further evaluation. Sometimes we find that patients referred to us have pseudo-seizures, not true seizures. Other children have multiple areas of abnormality and thus are not candidates for surgery. However, if the person is still a possible candidate, then the next step is to document that there is indeed a single seizure focus and that it is in an operable location. This will require video-EEG recording.

Video-EEG monitoring is the use of continuous monitoring of the EEG with simultaneous video recording to document both the clinical and the electrical onset of the seizures. It is essential to appropriate evaluation for surgery. The duration of this monitoring will depend on the center and on the frequency of the seizures. In general, we schedule one week in the monitoring unit, although for an individual with frequent seizures, a few days is often sufficient to analyze enough spells and determine if there is a consistent focus. If the seizures are less frequent, or if they subside in the hospital setting, as they often do, then we may withdraw one or more of the medications to permit seizures to be recorded. Since this drug withdrawal is done in the hospital setting, with trained personnel readily available should status epilepticus occur, the risk of abrupt withdrawal is minimized.

If, after careful analysis of the recorded seizures, a focus is identified, then consideration of surgery can proceed. If the abnormal area is situated far forward in the temporal or frontal lobes, areas that can be safely removed, then it may be possible to proceed directly to surgery. Surgery should never proceed, of course, until you and the surgeon have fully discussed the risks to your child, the chances of controlling the seizures, and any other questions you or your child may have.

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The combination of the enjoyable diet and your slow but steady weight loss will make daily weighings an enjoyable habit. If you are like most people who have used the Carbohydrate Addict’s Diet, you will begin to look forward to the end of the week and the averaging— it promises you an accurate look at your progress rather than potentially misleading readings that can occur with the once-a-week approach.

When you weigh yourself, you must also give up the idea that one weight at that particular moment is your weight; it really isn’t. That may sound strange, but look at it this way: that daily number cannot reflect minor and unpredictable fluctuations, for the same reason that a once-a-week weighing does not. Rather/your daily weight is to be thought of as but one part of seven parts of a week’s worth of weights.

If your weight is higher or lower than it has been, try to treat it simply as a piece of information. Don’t compare your weights from day to day—forget about it until week’s end.

Record your weight each day on your weight chart.

For the weeks that follow, continue to weigh yourself every day and record your daily weighing, averaging your weight (instructions above) every seven days. After fourteen days, you can compare the second week’s average with the first; that should be the first time you compare weights.

Don’t overreact to your weight: don’t abandon your eating plan just because your weight rises or falls. This program has been designed and refined by years of research, trial, error—and success. Stay with the program, and don’t decide to cheat or be harder on yourself just because of a daily fluctuation in your weight. Trust the Carbohydrate Addict’s Diet to work for you. This is a lifetime program, not a day-to-day diet.

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