Short-term and long-term efficacy of classical ketogenic diet and modified Atkins diet in children and adolescents with epilepsy: A systematic review and meta-analysis

Rezaei, Shahabeddin; Abdurahman, Ahmed Abdulahi; Saghazadeh, Amene; Badv, Reza Shervin; Mahmoudi, Maryam

doi:10.1080/1028415x.2017.1387721

Cited by 52 publications

(32 citation statements)

References 99 publications

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“…This meta-analysis confirmed the efficacy of the KD [68]. Another recent meta-analysis comparing the short-term and long-term efficacy of classic KD and MAD in children and adolescents with epilepsy, revealed no substantial difference between the two dietary regimens [82].…”

Section: Refractory Epilepsysupporting

confidence: 65%

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

Verrotti¹,

Iapadre²,

Francesco³

et al. 2020

Nutrients

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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.

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Section: Refractory Epilepsysupporting

confidence: 65%

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

Verrotti¹,

Iapadre²,

Francesco³

et al. 2020

Nutrients

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“…With a shortage of available glucose, fat from dietary source or stored adipose deposits is metabolized into ketone bodies [acetoacetate, β-hydroxybutyrate (βHB) and acetone] that can be utilized by the cells for energy. 1 Systematic reviews and meta-analyses have reported the effectiveness of ketogenic diets in treating intractable epilepsy in adults and children, 2,3 preventing an increase in appetite on reduced calorie diets, 4 and achieving longterm bodyweight reduction. 5 Emerging studies have shown that ketogenic diets may help diabetes management and improve exercise performance.…”

Section: Introductionmentioning

confidence: 99%

Acute oral intake of beta-hydroxybutyrate in a pilot study transiently increased its capillary levels in healthy volunteers

O’Connor¹,

Chang²,

Brownlow³

et al. 2018

JNHFE

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“…The time-consuming and effort-intensive characteristics of the KD possibly explain the large drop-out rate in the study by Wijnen BFM et al, perhaps justifying the lack of effect of KD on quality of life. [12][13][14]23 It would be important to have predictors of KD efficacy, so that we could prescribe it to those who would improve, as managing the diet is more time consuming than providing AEDs. Some researchers aimed to discover a link between etiology and epilepsy-type and response to KD, but until now they have not succeeded.…”

Section: Discussionmentioning

confidence: 99%

“…The outcome was classified in five groups: 100% seizure reduction or seizure free, from 90% to 99% seizure reduction, from 50% to 90% seizure reduction, less than 50% seizure reduction and no reduction. We defined efficacy in seizure control as a seizure reduction rate of 50% or higher, as reported by other groups 14 ;…”

Section: Efficacy Assessmentmentioning

confidence: 99%

“…Besides, there are a few randomized controlled trials in which one of the arms includes epileptic patients under KD. 1,10,[12][13][14] In this observational retrospective study, our aim was to evaluate the efficacy of KD therapies in childhood refractory epilepsy/EE, considering the protocol followed at our institution regarding seizure reduction, awareness and behavior improvement. Secondary objectives were to evaluate the main reasons for discontinuation, acute and chronic complications and the repercussion on patients' AED schedule.…”

Section: Introductionmentioning

confidence: 99%

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Ketogenic Diet for Refractory Childhood Epilepsy: Beyond Seizures Control, the Experience of a Portuguese Pediatric Centre

et al. 2019

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Introduction: Ketogenic diet is a low carbohydrate diet, which can be used as a treatment for refractory childhood epilepsy. The first aim of this study was to evaluate its efficacy, in patients receiving ketogenic diet for at least three months, on epilepsy control, behaviour and awareness. The secondary aims were to evaluate the variation in the number of antiepileptic drugs, reasons for discontinuing the diet and adverse effects. Material and Methods: Retrospective analysis of clinical records of patients who underwent ketogenic diet for refractory epilepsy, from October 2007 to January 2018, in a tertiary pediatric hospital. Results: In the twenty-nine eligible patients, the mean age of initiation was 7.9 years-old (+/-5.6). Of those, 18 had a ≥ 50% reduction of seizure activity, 19 a marked behaviour improvement and 18 improved awareness. The median number of antiepileptic drugs remained equal for the 15 patients who completed 18 months of treatment (three drugs). The main reason for discontinuing ketogenic diet was a familiar decision. The main adverse effects were hypercholesterolemia (n = 23) and hypertriglyceridemia (n = 21). Discussion: Results were comparable to those of other cohorts, namely age of initiation, proportion of patients completing ketogenic diet, most frequent reasons for stopping and significant improvement of alertness and behavior. Conclusion: Beyond seizure control, patients experienced a marked improvement in behavior and awareness. It is necessary to develop strategies to increase the adherence of families to the diet. RESUMOIntrodução: A dieta cetogénica é uma dieta com baixo teor de hidratos de carbono, que pode ser usada no tratamento da epilepsia infantil refratária. O principal objetivo deste estudo foi avaliar a eficácia nos doentes que completaram pelo menos três meses de dieta, no que respeita ao controlo das crises, comportamento e estado de alerta. Foi também avaliada a variação do número de fármacos antiepiléticos, as razões de descontinuação e os efeitos secundários. Material e Métodos: Análise retrospetiva dos processos clínicos dos doentes com epilepsia refratária sob dieta cetogénica, de outubro de 2007 a janeiro de 2018, num hospital pediátrico de nível 3. Resultados: Nos 29 doentes elegíveis, a média da idade de implementação foi 7,9 anos (+/-5,6). Destes, 18 tiveram uma redução ≥ 50% das crises, 19 tiveram uma melhoria marcada do comportamento e 18 do seu estado de alerta. Dos 15 que completaram 18 meses, a mediana do número de fármacos antiepiléticos permaneceu idêntica à do início (três fármacos). A principal razão de descontinuação foi por decisão familiar. Os principais efeitos secundários foram a hipercolesterolémia (n = 23) e a hipertrigliceridémia (n = 21). Discussão: Os resultados foram semelhantes aos obtidos noutras coortes, nomeadamente no que respeita à idade de início, à percentagem de doentes que completou a dieta, às razões da suspensão e à melhoria do comportamento e estado de alerta. Conclusão: Para além do controlo das crises, os doentes tiveram u...

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Short-term and long-term efficacy of classical ketogenic diet and modified Atkins diet in children and adolescents with epilepsy: A systematic review and meta-analysis

Abstract: Classical KD does not differ substantially from MAD in ≥50% and ≥90% reduction of seizure frequency at month-3 and month-6. Overall, the number of patients achieving seizure freedom increases over time.

Cited by 52 publications

References 99 publications

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

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

Acute oral intake of beta-hydroxybutyrate in a pilot study transiently increased its capillary levels in healthy volunteers

Ketogenic Diet for Refractory Childhood Epilepsy: Beyond Seizures Control, the Experience of a Portuguese Pediatric Centre

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