Diet in the Treatment of Epilepsy: What We Know So Far

Abstract

Epilepsy is a chronic and debilitating neurological disorder, with a worldwide prevalence of 0.5–1% and a lifetime incidence of 1–3%. An estimated 30% of epileptic patients continue to experience seizures throughout life, despite adequate drug therapy or surgery, with a major impact on society and global health. In recent decades, dietary regimens have been used effectively in the treatment of drug-resistant epilepsy, following the path of a non-pharmacological approach. The ketogenic diet and its variants (e.g., the modified Atkins diet) have an established role in contrasting epileptogenesis through the production of a series of cascading events induced by physiological ketosis. Other dietary regimens, such as caloric restriction and a gluten free diet, can also exert beneficial effects on neuroprotection and, therefore, on refractory epilepsy. The purpose of this review was to analyze the evidence from the literature about the possible efficacy of different dietary regimens on epilepsy, focusing on the underlying pathophysiological mechanisms, safety, and tolerability both in pediatric and adult population. We believe that a better knowledge of the cellular and molecular biochemical processes behind the anticonvulsant effects of alimentary therapies may lead to the development of personalized dietary intervention protocols.

Mechanisms of Drug Resistance in the Pathogenesis of Epilepsy: Role of Neuroinflammation. A Literature Review

“…It is considered promising to switch to a ketogenic diet, for example, the modified Atkins diet [52], which has been used since 2003 to treat children and adults with refractory epilepsy at Johns Hopkins Hospital in Maryland, USA [53]. Other dietary regimens, such as calorie restriction and a gluten-free diet, can also have a positive effect [54]. In the absence of an effect, drugs based on cannabidiol or its synthetic analogues can be prescribed as palliative care, reducing the number of epileptic seizures in about 80% of patients but the frequency of side effects is high-from 42 to 71.4% [55,56].…”

Diet in the Treatment of Epilepsy

“…Verrotti and colleagues review the evidence-based literature in regard to the use of high-fat diets in the treatment of epilepsy with a focus on the classic ketogenic diet as well as some popular high-fat diet variants including the modified Atkins diet, low glycemic index diet and medium-chain triglyceride diet, which are less restrictive and more palatable [ 2 ]. The authors discuss possible mechanisms underlying the success of the ketogenic diet including increased ketone bodies, altered neurotransmitter levels and energy metabolism, increased levels of polyunsaturated fatty acids, reduced apoptosis and changes in intestinal microbiota and the production of pro-inflammatory cytokines.…”

The Pharmacoresistant Epilepsy: An Overview on Existent and New Emerging Therapies

“…Among non-pharmacological treatments for DRE there is the ketogenic diet. This strict dietary regimen has been generally reserved for a specific group of children with DRE and is characterized by high-fat and low-carbohydrate levels, which mimic fasting ( 141 , 142 ). However, it is not usually long-term used due to concerns about effects on growth and overall health.…”