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

Jana Wells,Arun Swaminathan,Corrine Hanson,Jenna Paseka

doi:10.3390/nu12061809

Jana Wells, Arun Swaminathan + Show 2 more

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https://doi.org/10.3390/nu12061809

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Abstract

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.

Highlights

Epilepsy in the pediatric and adolescent population is a devastating condition where individuals are prone to recurrent epileptic seizures or a change in behavior or movement that is the direct result of a primary change in the electrical activity in the brain [1]
Materials and Methods A literature search was performed using MEDLINE and PUBMED to locate peer-reviewed articles of observational studies, clinical trials or meta-analysis reporting the results of ketogenic diet therapy on refractory epilepsy outcomes in children and adolescents
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 [17]

Summary

Introduction

Epilepsy in the pediatric and adolescent population is a devastating condition where individuals are prone to recurrent epileptic seizures or a change in behavior or movement that is the direct result of a primary change in the electrical activity in the brain [1]. Up to 65% of individuals with epilepsy will have seizures controlled with antiepileptic drugs (ASMs) or enter spontaneous remission in their lifetime [2]. This leaves a large percentage of patients that are refractory to drug therapy. Current methods for treating refractory epilepsy include surgery, vagus nerve stimulation or a Ketogenic Diet (KD). Prior to development of the KD, historical iterations of the use of fasting to treat epilepsy have been documented from at least 500 BC. Fasting was noted as a therapeutic measure against epilepsy in the Hippocratic collection and was referred to again in the King James Version of the Bible 5 centuries later [3]. In 1921, Woodyatt et al observed that ketones, acetone and β-hydroxybutyric acid, appeared in subjects either by starvation or by consuming a high fat and very low carbohydrate diet [4]

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