The role of the ketogenic diet in the treatment of epilepsy
DOI:
https://doi.org/10.12775/QS.2024.26.55234Keywords
epilepsy, ketogenic diet, modified Atkins diet, low glycemic index, drug-resistance epilepsyAbstract
Introduction:
Epilepsy is a prevalent neurological condition that continues to pose therapeutic challenges. Despite the availability of various antiepileptic medications, up to one-third of patients still experience insufficient control of their seizures. One approach to managing epilepsy, particularly in drug-resistant cases, is the ketogenic diet. This diet, along with its variations, has shown effectiveness in reducing seizures across all age groups, with additional improvements in behavior. However, despite numerous studies, the exact mechanisms behind its therapeutic effects and potential risks to the body remain unclear. This review of the current literature outlines the fundamental principles and variations of the ketogenic diet, evaluates its safety and effectiveness in treating epilepsy, and explores the possible mechanisms underlying its success.
Materials and methods:
This article is based on the literature found in the PubMed database with the use of keywords like: "drug resistance epilepsy", "ketogenic diet", "epilepsy treatment".
Conclusion:
The ketogenic diet is an effective treatment for epilepsy, especially drug-resistant forms. It reduces the number of seizures and it also has a positive effect on patients' sleep and cognitive functions. Despite many years of using the diet and observing its effects we still do not fully understand its mechanisms of action.
References
El-Shafie AM, Bahbah WA, Abd El Naby SA, Omar ZA, Basma EM, Hegazy AAA, El Zefzaf HMS. Impact of two ketogenic diet types in refractory childhood epilepsy. Pediatr Res. 2023 Dec;94(6):1978-1989. doi: 10.1038/s41390-023-02554-w. Epub 2023 Mar 11. PMID: 36906721; PMCID: PMC10007663.
Wells J, Swaminathan A, Paseka J, Hanson C. Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy-A Review. Nutrients. 2020 Jun 17;12(6):1809. doi: 10.3390/nu12061809. PMID: 32560503; PMCID: PMC7353240
Zarnowska IM. Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned. Nutrients. 2020 Aug 27;12(9):2616. doi: 10.3390/nu12092616. PMID: 32867258; PMCID: PMC7551948.
Sampaio LP. Ketogenic diet for epilepsy treatment. Arq Neuropsiquiatr. 2016 Oct;74(10):842-848. doi: 10.1590/0004-282X20160116. PMID: 27759811.
Dyńka D, Kowalcze K, Paziewska A. The Role of Ketogenic Diet in the Treatment of Neurological Diseases. Nutrients. 2022 Nov 24;14(23):5003. doi: 10.3390/nu14235003. PMID: 36501033; PMCID: PMC9739023.
McGaugh E, Barthel B. A Review of Ketogenic Diet and Lifestyle. Mo Med. 2022 Jan-Feb;119(1):84-88. PMID: 36033148; PMCID: PMC9312449.
Muzykewicz DA, Lyczkowski DA, Memon N, Conant KD, Pfeifer HH, Thiele EA. Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy. Epilepsia. 2009 May;50(5):1118-26. doi: 10.1111/j.1528-1167.2008.01959.x. Epub 2009 Feb 12. PMID: 19220406.
Zhu H, Bi D, Zhang Y, Kong C, Du J, Wu X, Wei Q, Qin H. Ketogenic diet for human diseases: the underlying mechanisms and potential for clinical implementations. Signal Transduct Target Ther. 2022 Jan 17;7(1):11. doi: 10.1038/s41392-021-00831-w. PMID: 35034957; PMCID: PMC8761750.
Mishra P, Singh SC, Ramadass B. Drug resistant epilepsy and ketogenic diet: A narrative review of mechanisms of action. World Neurosurg X. 2024 Feb 25;22:100328. doi: 10.1016/j.wnsx.2024.100328. PMID: 38444870; PMCID: PMC10914588.
Kessler SK, Gallagher PR, Shellhaas RA, Clancy RR, Bergqvist AG. Early EEG improvement after ketogenic diet initiation. Epilepsy Res. 2011 Mar;94(1-2):94-101. doi: 10.1016/j.eplepsyres.2011.01.012. Epub 2011 Feb 23. PMID: 21345653; PMCID: PMC3062190.
Pizzo F, Collotta AD, Di Nora A, Costanza G, Ruggieri M, Falsaperla R. Ketogenic diet in pediatric seizures: a randomized controlled trial review and meta-analysis. Expert Rev Neurother. 2022 Feb;22(2):169-177. doi: 10.1080/14737175.2022.2030220. Epub 2022 Feb 25. PMID: 35144527.
Miranda MJ, Mortensen M, Povlsen JH, Nielsen H, Beniczky S. Danish study of a modified Atkins diet for medically intractable epilepsy in children: can we achieve the same results as with the classical ketogenic diet? Seizure. 2011 Mar;20(2):151-5. doi: 10.1016/j.seizure.2010.11.010. Epub 2010 Dec 3. PMID: 21126887.
Sharma S, Sankhyan N, Gulati S, Agarwala A. Use of the modified Atkins diet for treatment of refractory childhood epilepsy: a randomized controlled trial. Epilepsia. 2013 Mar;54(3):481-6. doi: 10.1111/epi.12069. Epub 2013 Jan 7. PMID: 23294191.
Manral M, Dwivedi R, Gulati S, Kaur K, Nehra A, Pandey RM, Upadhyay AD, Sapra S, Tripathi M. Safety, Efficacy, and Tolerability of Modified Atkins Diet in Persons With Drug-Resistant Epilepsy: A Randomized Controlled Trial. Neurology. 2023 Mar 28;100(13):e1376-e1385. doi: 10.1212/WNL.0000000000206776. Epub 2023 Jan 4. PMID: 36599697; PMCID: PMC10065201.
Neal EG, Chaffe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G, Whitney A, Cross JH. A randomized trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia. 2009 May;50(5):1109-17. doi: 10.1111/j.1528-1167.2008.01870.x. Epub 2008 Nov 19. PMID: 19054400.
Devi N, Madaan P, Kandoth N, Bansal D, Sahu JK. Efficacy and Safety of Dietary Therapies for Childhood Drug-Resistant Epilepsy: A Systematic Review and Network Meta-analysis. JAMA Pediatr. 2023 Mar 1;177(3):258-266. doi: 10.1001/jamapediatrics.2022.5648. PMID: 36716045; PMCID: PMC9887534.
Kang HC, Kim HD. Diet therapy in refractory pediatric epilepsy: increased efficacy and tolerability. Epileptic Disord. 2006 Dec;8(4):309-16. PMID: 17150447.
Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Christina Bergqvist AG, Blackford R, Buchhalter JR, Caraballo RH, Helen Cross J, Dahlin MG, Donner EJ, Klepper J, Jehle RS, Kim HD, Christiana Liu YM, Nation J, Nordli DR Jr, Pfeifer HH, Rho JM, Stafstrom CE, Thiele EA, Turner Z, Wirrell EC, Wheless JW, Veggiotti P, Vining EP; Charlie Foundation, Practice Committee of the Child Neurology Society; Practice Committee of the Child Neurology Society; International Ketogenic Diet Study Group. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304-17. doi: 10.1111/j.1528-1167.2008.01765.x. Epub 2008 Sep 23. PMID: 18823325.
Faheem Y, Jaiswal A, Shergill K, Boppana K, Almansouri NE, Bakkannavar S, Yu AK. Keto Clarity: A Comprehensive Systematic Review Exploring the Efficacy, Safety, and Mechanisms of Ketogenic Diet in Pediatric Epilepsy. Cureus. 2024 Feb 25;16(2):e54863. doi: 10.7759/cureus.54863. PMID: 38533170; PMCID: PMC10964213.
Borowicz-Reutt K, Krawczyk M, Czernia J. Ketogenic Diet in the Treatment of Epilepsy. Nutrients. 2024 Apr 24;16(9):1258. doi: 10.3390/nu16091258. PMID: 38732505; PMCID: PMC11085120.
Ko A, Kwon HE, Kim HD. Updates on the ketogenic diet therapy for pediatric epilepsy. Biomed J. 2022 Feb;45(1):19-26. doi: 10.1016/j.bj.2021.11.003. Epub 2021 Nov 19. PMID: 34808422; PMCID: PMC9133260.
Boison D. New insights into the mechanisms of the ketogenic diet. Curr Opin Neurol. 2017 Apr;30(2):187-192. doi: 10.1097/WCO.0000000000000432. PMID: 28141738; PMCID: PMC5409832.
Gough SM, Casella A, Ortega KJ, Hackam AS. Neuroprotection by the Ketogenic Diet: Evidence and Controversies. Front Nutr. 2021 Nov 23;8:782657. doi: 10.3389/fnut.2021.782657. PMID: 34888340; PMCID: PMC8650112.
Gibbon FM, Maccormac E, Gringras P. Sleep and epilepsy: unfortunate bedfellows. Arch Dis Child. 2019 Feb;104(2):189-192. doi: 10.1136/archdischild-2017-313421. Epub 2018 Sep 28. PMID: 30266875; PMCID: PMC6362435.
Parisi P, Bruni O, Pia Villa M, Verrotti A, Miano S, Luchetti A, Curatolo P. The relationship between sleep and epilepsy: the effect on cognitive functioning in children. Dev Med Child Neurol. 2010 Sep;52(9):805-10. doi: 10.1111/j.1469-8749.2010.03662.x. Epub 2010 Mar 29. PMID: 20370812.
Hallböök T, Lundgren J, Rosén I. Ketogenic diet improves sleep quality in children with therapy-resistant epilepsy. Epilepsia. 2007 Jan;48(1):59-65. doi: 10.1111/j.1528-1167.2006.00834.x. PMID: 17241208.
van Berkel AA, IJff DM, Verkuyl JM. Cognitive benefits of the ketogenic diet in patients with epilepsy: A systematic overview. Epilepsy Behav. 2018 Oct;87:69-77. doi: 10.1016/j.yebeh.2018.06.004. Epub 2018 Aug 31. PMID: 30173019.
Garcia-Penas JJ. Epilepsia, cognicion y dieta cetogenica [Epilepsy, cognition and ketogenic diet]. Rev Neurol. 2018 Mar 1;66(S01):S71-S75. Spanish. PMID: 29516456.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Karolina Kusiak, Anna Kuśnierz, Marta Głąbień, Daria Aleksandrowicz, Zofia Jakubczak, Paweł Miłkowski, Maria Weronika Zimniak, Aneta Kondratowicz, Olga Wieczorek, Patryk Śliwiak
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 98
Number of citations: 0