Abstract
Ketogenic diet (KD) has been used to treat epilepsy for 100 years. It is a high-fat, low-carbohydrate, and sufficient-protein-for-growth diet that mimics the metabolic changes occurring during starvation. Except for classic KD, its modified counterparts, including modified Atkins diet and low-glycemic-index treatment, have gained grounds to increase palatability and adherence. Strong evidence exists that the KD offers protection against seizures in difficult-to-treat epilepsy and possesses long-lasting anti-epileptic activity, improving long-term disease outcome. The KD can also provide symptomatic and disease-modifying activity in a wide range of neurodegenerative diseases. In an era of highly available new anti-seizure medications (ASMs), the challenge of refractory epilepsy has still not been solved. This metabolic therapy is increasingly considered due to unique mechanisms and turns out to be a powerful tool in the hands of a skillful team. Despite decades of extensive research to explain the mechanism of its efficacy, the precise mechanism of action is to date still largely unknown. The key feature of this successful diet is the fact that energy is derived largely from fat but not from carbohydrates. Consequently, fundamental change occurs regarding the method of energy production that causes alterations in numerous biochemical pathways, thus restoring energetic and metabolic homeostasis of the brain. There are barriers during the use of this special and individualized therapy in many clinical settings worldwide. The aim of this review is to revisit the current state of the art of therapeutic application of KD in refractory epilepsy.
Highlights
Prolonged periods of fasting have been used to treat epilepsy since ancient times and are dated back to 500 BC [1]
Fasting as a treatment continued up to the 1920s but the true origin of classic ketogenic diet is dated in 1921 when Rollin Turner Woodyatt noted that the ketones, acetone and β-hydroxybutyrate (BHB), were formed in normal fasted subjects
Reported rates of seizure freedom reached as high as 55% in classical 4:1 ketogenic diet (KD) group after 3 months and >50% seizure reduction might occur up to 85% of children
Summary
Prolonged periods of fasting have been used to treat epilepsy since ancient times and are dated back to 500 BC [1]. After increasing availability of anti-seizure medications (ASMs), the application of KD became less popular due to perceived unpalatability and poor adherence. This led to fewer dieticians trained in KD administration, a change in the perception of its efficacy in epilepsy. Nutrients 2020, 12, 2616 of successful application of the classic KD in influential patient, Charlie Abrahams and disappointingly high percentage of refractory epilepsy (~30%) worldwide, despite the development of new ASMs. Soon later, Charlie’s parents, Jim and Nancy Abrahams, created the Charlie Foundation which made information regarding the KD therapy available to other parents, medical providers and the public [4].
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