Ketogenic diet in Zambia: Managing drug-resistant epilepsy in a low and middle income country

Abstract

Globally, drug-resistant epilepsy affects one third of people living with epilepsy. With limitations in treatment options for refractory epilepsy in resource-limited regions, ketogenic diet therapy is an important option to consider. Utilizing the 2015 International League Against Epilepsy recommended minimum requirements for ketogenic diet therapy, three male children with refractory epilepsy, aged 2.5, 6.5 and 10 years, were initiated on the classical ketogenic diet using locally available food in August 2017 at University Teaching Hospitals-Children's Hospital in Lusaka, Zambia, through partnership with the Epilepsy Program at Boston Children's Hospital in the United States. Following successful initiation in all three children, the diet was discontinued in the 10-year-old due to difficulties complying with the diet. The youngest child demonstrated an over 50% seizure reduction and gained developmental milestones. The third child achieved seizure freedom and showed marked improvement in behaviour. This pilot demonstrates the feasibility of ketogenic diet as an important therapeutic option for refractory epilepsy in Zambia. Given the limitations in treatment choices and medication accessibility, dietary therapy offers an alternative management strategy in our setting. Collaboration with an established ketogenic diet centre contributes to a successful program.

A ketogenic diet enhances fluconazole efficacy in murine models of systemic fungal infection

“…However, the rapid antifungal effect of KD after only several days has implications for a clinical setting, in which a dietary intervention can be introduced during an established infection. For instance, several studies have found that a KD is a feasible treatment intervention for pediatric epilepsy in LMICs, and success is increased when administered in hospital settings ( 43 – 46 ). Furthermore, a KD was found to significantly alter the human immune system, microbiome, and metabolome after just 2 weeks of therapy ( 47 ).…”

Challenges faced by people with epilepsy on ketogenic diet therapy and their caregivers during the COVID-19 pandemic in Brazil

“…Furthermore, a recent study in Canada [13] evidenced that PWE, who initiated KDT, experienced decreased emergency department visits and inpatient visits, and healthcare costs. Additionally, KDT is becoming a rising trend in resource-limited countries, with successful experiences in Egypt [14] and Zambia [15] .…”

Epilepsy in Africa: a multifaceted perspective on diagnosis, treatment, and community support

“…The ketogenic diet, which consists of a low carbohydrate, high fat, and moderate protein intake, is a popular therapeutic choice for drug-resistant epilepsy in children and is used extensively in the majority of specialized paediatric epileptic centres worldwide 21 . This type of diet has shown promising results in research done in Zambia among paediatric drug-resistant epileptic patients 22 . Because of cost, a shortage of neurosurgeons, and a lack of infrastructure to support advanced technologies, most of sub-Saharan Africa does not have access to epilepsy surgery such as resection surgery, deep brain stimulation, corpus callosotomy, hemispherectomy, or other less invasive techniques 23 .…”