Ketogenic diets for drug-resistant epilepsy

Martin‐McGill, Kirsty J; Bresnahan, Rebecca; Levy, Robert G; Cooper, Paul

doi:10.1002/14651858.cd001903.pub5

Cited by 171 publications

(183 citation statements)

References 49 publications

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“…Initial cohorts and randomized controlled trials (RCTs) validated the ability of the cKD to significantly reduce seizure frequency [ 25 , 26 ] while later studies attempted to assess the need for high KD ratios [ 27 , 28 , 29 , 30 ]. A prospective cohort of children on a cKD with a 2:1 KD ratio found a greater than 50% seizure reduction was achieved in 52%, 43%, 40%, 33% and 30% of subjects at 3, 6, 12, 24 and greater than 3 years follow up.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy—A Review

et al. 2020

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Epilepsy in the pediatric and adolescent populations is a devastating condition where individuals are prone to recurrent epileptic seizures or changes in behavior or movement that is the direct result of a primary change in the electrical activity in the brain. Although many children with epilepsy will have seizures controlled with antiseizure medications (ASMs), a large percentage of patients are refractory to drug therapy and may consider initiating a ketogenic diet. The term Ketogenic Diet or Ketogenic Diet Therapy (KDT) refers to any diet therapy in which dietary composition results in a ketogenic state of human metabolism. Currently, there are 4 major Ketogenic diet therapies—the classic ketogenic diet (cKD), the modified Atkins diet (MAD), the medium chain triglyceride ketogenic diet (MCTKD) and the low glycemic index treatment (LGIT). The compositions of the 4 main KDTs differ and limited evidence to distinguish the efficacy among different diets currently exists. Although it is apparent that more randomized controlled trials (RCTs) and long-term studies are needed to evaluate efficacy, side effects and individual response to the diet, it is imperative to study and understand the metabolic profiles of patients with epilepsy in order to isolate which dietary restrictions are necessary to maximize clinical benefit.

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Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy—A Review

et al. 2020

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“…Semistarvation ketogenic diets containing <800 kcal are primarily used therapeutically in the treatment of modest to severe obesity to produce a rapid and safe weight loss that largely spares lean tissue during the weight loss phase . Eucaloric ketogenic diets that meet energy requirements to allow for growth in children have long been used successfully for the management of drug‐resistant epilepsy . They have more recently been used for their putative benefits in competitive sports and in the management of type 2 diabetes in overweight and obese individuals .…”

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confidence: 99%

“…The increasing clinical use of eucaloric ketogenic diets for purposes of improved control of epilepsy and management of type 1 diabetes in the young and type 2 diabetes in the obese has reawakened interest in the possible unique metabolic consequences which could influence energy balance with very low carbohydrate intake that allows substantial ketonemia. Paramount among these considerations would be the differential effects of sustained ketogenesis and ketonemia on the 2 principal components of the energy balance equation: those affecting energy intake and particularly those impacting energy expenditure.…”

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confidence: 99%

Some Musings About Differential Energy Metabolism With Ketogenic Diets

Bistrian

2019

J Parenter Enteral Nutr

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Ketogenic states are of 3 major types: total starvation and those resulting from the consumption of semistarvation, ketogenic diets, and eucaloric ketogenic diets. All are characterized by little or no dietary carbohydrate, resulting in a fat‐based metabolism with sustained ketonemia of varying degrees in each state. The latter 2 diets are clinically useful with important impacts on both aspects of the energy balance equation with increased satiety and less hunger on the intake side and probably increased energy expenditure on the output side; both may have important implications for the successful long‐term management of obesity. Consideration of older research regarding the hormonal response to carbohydrate‐free dieting and recent findings on hepatic glycogen status that occurs with sustained ketonemia support the likelihood that there are profound differences in 24‐hour gluconeogenesis rates between ketogenic diets and balanced diets containing substantial carbohydrate. This metabolic distinction could have a meaningful impact to increase the thermic effect of feeding and daily energy expenditure amounting to 100 kcal/d or more with each of the ketogenic diets.

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“…Ketogenic diets are high‐fat, low‐carbohydrate, moderate protein diets used as a treatment option for drug‐resistant epilepsy. These diets are the treatment of choice for rare, neurometabolic disorders, such as glucose transport type 1 deficiency syndrome and pyruvate dehydrogenase deficiency, and are effective in reducing seizure frequency in approximately 40% of patients with epilepsy …”

mentioning

confidence: 78%