Ketogenic diet for epilepsy control and enhancement in adaptive behavior

Abstract

The Ketogenic Diet (KD) is gaining attention as a management line in childhood drug resistant epilepsy (DRE). The objective of this study was to highlight KD benefits for Ain Shams University (ASU) Children’s Hospital patients. This cross-sectional study included all patients at the Ketoclinic of ASU Children’s Hospital since it started. Anthropometric measurements and laboratory data were recorded. Chalfont severity score and daily frequency of epileptic attacks were used to evaluate KD efficacy. Vineland test was used to demonstrate the adaptive behavior of a selected group of patients. ASU Children’s Hospital Ketoclinic records included 143 patients. During KD therapy, the weight and height/length assessment showed significant increase with significant decrease in the severity of seizures and its frequency. There were no significant changes in the lipid profile of the patients. Vineland test showed significant improvement in the adaptive behavior in 65% of patients. The Ketoclinic data proves that KD is a tolerable, safe, and effective line of therapy for DRE in children without significant negative impact on their anthropometric measurements or lipid profile. Furthermore, the enhancement in adaptive behavior is a promising finding. It is prudent to recommend wider scale studies for longer duration to demonstrate additional cognitive benefits of KD in pediatric age group.

Ketogenic diet in childhood epilepsy: clinical algorithm in a tertiary care center

“…An algorithm designed to regulate the implementation of the diet can facilitate the tracking of nutrient intake, blood ketone levels, and other essential parameters, ensuring the safety and effectiveness of the diet (26). In our previous studies, the KDA has proven to be a valuable tool in making the ketogenic diet a tolerable, safe, and effective therapy for children with drug-resistant epilepsy without significantly impacting their anthropometric measurements or lipid profiles (7,11,13). Developing a flexible algorithm is preferable to previous fixed ketogenic diet protocols, such as restrictive protocols and prolonged fasting (35).…”

“…Following a well-defined algorithm has been associated with an increased success rate in treating drug resistant epilepsy with the ketogenic diet. Early protocols for the ketogenic diet resulted in a success rate of approximately 25% in treating drug resistant refractory epilepsy in children (36), which increased to 56% after implementing a well-defined algorithm (7,11,13).…”

“…This algorithm guides medical professionals in making informed decisions and monitoring patients' progress. It has been previously validated through a study conducted by the same team (13).…”

Pediatric Epilepsy and its Health Conditions in UAE: A Review Article

“…Ketone diet therapy is not successful for patients having problems with fatty acid metabolism and oxidation; therefore, a complete examination must be carried out for all these problems (Anwar et al, 2020). Several researchers prove that the ketone diet reduces the frequency of epileptic seizures in about 30-40% of children due to its anticonvulsive properties, affecting both the neurotransmitters and neuronal membrane (Cicek & Sanlier, 2023;El-Rashidy et al, 2023). In neuronal membranes, the ketogenic diet modifies the vesicular glutamate transporters that are chloride ion-dependent and work by filling presynaptic vesicles.…”

Characterization of β-Hydroxybutyrate as a Cell Autonomous Fuel for Active Excitatory and Inhibitory Neurons

“…Besides the standard mitochondrial fuel of pyruvate, there is evidence that alternative carbon sources such as amino acids and glycerol can be metabolized by mitochondria to support neuronal function ( Divakaruni et al, 2017 ; Dhoundiyal et al, 2022 ). Ketone bodies are a notable example of an alternative mitochondrial fuel, as the ketogenic diet is in use as a therapy for medication-refractory cases of epilepsy ( El-Rashidy et al, 2023 ) and is effective in about 40% of these cases ( Ye et al, 2015 ). There are multiple proposed mechanisms for the therapeutic effect of the ketogenic diet including epigenetic modifications, neuroprotective signaling, antioxidant activity, and metabolic shifts leading to shifts in the ratio of excitation to inhibition ( Murugan and Boison, 2020 ; Ma et al, 2007 ; Juge et al, 2010 ; Qiao et al, 2024 ), each with varying amounts of supporting evidence.…”