Ketogenic diets for drug-resistant epilepsy

Abstract

Background Ketogenic diets (KDs), being high in fat and low in carbohydrates, have been suggested to reduce seizure frequency in people with epilepsy. At present, such diets are mainly recommended for children who continue to have seizures despite treatment with antiepileptic drugs (AEDs) (drug-resistant epilepsy). Recently, there has been interest in less restrictive KDs, including the modified Atkins diet (MAD), and the use of these diets has extended into adult practice. This is an update of a review first published in 2003 and last updated in 2016. Objectives To assess the e ects of KDs for drug-resistant epilepsy by reviewing the evidence from randomised controlled trials.

Some Musings About Differential Energy Metabolism With Ketogenic Diets

“…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 .…”

“…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.…”

Biochemical assessment of patients following ketogenic diets for epilepsy: Current practice in the UK and Ireland

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

Intravenous ketogenic diet: guidelines for ketogenic parenteral therapy

“…1,2 The rationale behind the latter concept stems from recognition that the ketogenic diet works very quickly, has no obvious drug interactions, and can be provided relatively easily in intensive care settings via nasogastric tubes. Two of the fastest growing new indications are the use of the ketogenic diet in infancy and as a treatment for super-refractory status epilepticus.…”

“…1 In a ketogenic diet, circulating ketone bodies increase the acidic milieu of the body and thus, the risk of metabolic acidosis, with the potential consequences of nephrolithiasis, nephrocalcinosis, and bone mineral density loss. Yet it is by no means definitive, and more patients as well as prospective trials are required in order to guide this unique method of providing ketogenic therapy.…”