Cognitive benefits of the ketogenic diet in patients with epilepsy: A systematic overview

Abstract

The ketogenic diet (KD) has been found to be effective in reducing seizures in patients with treatment-refractory epilepsy. Less attention has been paid to additional cognitive benefits of KD. The aim of the present paper was to provide a comprehensive overview of the studies reporting effects on cognition after KD treatment in adults and children with epilepsy. To address this aim, the clinical literature on cognitive effects of KD in patients with epilepsy was reviewed using a systematic approach. We conclude that using subjective assessments of the patient's experience, cognitive improvements are frequently reported during KD treatment in the domains of alertness, attention, and global cognition. Studies that used objective neuropsychological tests confirmed benefits on alertness but found no improvement in global cognition. There are indications that these improvements are caused by both seizure reduction and direct effects of KD on cognition. The improvements appear to be unrelated to medication reduction, age when KD is started, type of KD, and sleep improvement. The findings in the present overview contribute to a better understanding of the beneficial effects of KD in patients with epilepsy.

Effectiveness, retention, and safety of modified ketogenic diet in adults with epilepsy at a tertiary-care centre in the UK

“…For example, 31% of participants in this study reported cognitive benefits of MKD, including increased mental alertness and improved mood. It has previously been shown that MKD increases mental alertness, and that this is associated with both a reduction in seizures and diet itself [38].…”

Effective and safe diet therapies for Lennox-Gastaut syndrome with mitochondrial dysfunction

“…25 Although it is difficult to establish firm conclusions due to confounding factors, the positive impact of DTs on cognition is widely acknowledged. [25][26][27] In patients with LGS with mitochondrial dysfunction, cognitive decline and seizures are important factors for treatment. In general, the cognitive status of LGS with mitochondrial dysfunction is too low to be evaluated, and cognitive status is difficult to quantify as a prognostic method due to the rarity of this pediatric condition.…”

Neuromodulation of Glial Function During Neurodegeneration

“…Recently, strategies directed towards targeting the astrocytic glutamate transporter EAAT2 proved to be beneficial in alleviating the hyperexcitability symptoms associated with some neurodegenerative diseases and decrease the level of neurodegeneration in animal models of epilepsy (Kong et al, 2012(Kong et al, , 2014Goodrich et al, 2013;Zaitsev et al, 2019), ALS (Kong et al, 2014), PD (Chotibut et al, 2014;Hsu et al, 2015) and HD (Sari et al, 2010). Moreover, modulation of astrocytic energy metabolism via inhibition of lactate dehydrogenase (Sada et al, 2015;Rosati et al, 2018) or via ketonic diet (Valdebenito et al, 2016) had a neuroprotective effect in both animal models of PD (Shaafi et al, 2016), and patients with HD (Adanyeguh et al, 2015) and epilepsy (van Berkel et al, 2018). Also, treatments that targeted the suppression of the inflammatory NF-κB pathway by increasing the expression of neurotrophic growth factor IGF-1 (Hu et al, 2018), or decreasing microglial proliferation (Martínez-Muriana et al, 2016), postponed the onset and slowed down the progression of motoneuron death in a mouse model of ALS.…”