Ketogenic Diet in the Treatment of Epilepsy

Abstract

Epilepsy is one of the most disabling neurological diseases. Despite proper pharmacotherapy and the availability of 2nd and 3rd generation antiepileptic drugs, deep brain stimulation, and surgery, up to 30-40% of epilepsy patients remain drug-resistant. Consequences of this phenomenon include not only decreased a quality of life, and cognitive, behavioral, and personal disorders, but also an increased risk of death, i.e., in the mechanism of sudden unexpected death in epilepsy patients (SUDEP). The main goals of epilepsy treatment include three basic issues: achieving the best possible seizure control, avoiding the undesired effects of treatment, and maintaining/improving the quality of patients' lives. Therefore, numerous attempts are made to offer alternative treatments for drug-resistant seizures, an example of which is the ketogenic diet. It is a long-known but rarely used dietary therapy for intractable seizures. One of the reasons for this is the unpalatability of the classic ketogenic diet, which reduces patient compliance and adherence rates. However, its antiseizure effects are often considered to be worth the effort. Until recently, the diet was considered the last-resort treatment. Currently, it is believed that a ketogenic diet should be used much earlier in patients with well-defined indications. In correctly qualified patients, seizure activity may be reduced by over 90% or even abolished for long periods after the diet is stopped. A ketogenic diet can be used in all age groups, although most of the available literature addresses pediatric epilepsy. In this article, we focus on the mechanisms of action, effectiveness, and adverse effects of different variants of the ketogenic diet, including its classic version, a medium-chain triglyceride diet, a modified Atkins diet, and a low glycemic index treatment.

Keywords: KD; efficacy; epilepsy; ketogenic diet; safety; seizure.

Figure 1

Percentage compositions of the classic KD and its modifications [2,3,6,8,14,15,16].

Figure 2

Leading mechanisms of action of the ketogenic diet leading to neuronal hyperpolarization [22,23,24,25]. ↑, increased; ↓, decreased; AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; GLU, glutamate; NA, norepinephrine; DA, dopamine; 5-HT, serotonin; GAL, galanin; NPY, neuropeptide Y; BDNF, brain-derived neurotrophic factor; GABA, γ-aminobutyric acid; ATP, adenosine triphosphate.