Ketogenic diet for the treatment of pediatric epilepsy: review and meta-analysis

Sourbron, Jo; Klinkenberg, Sylvia; Kuijk, Sander M. J. van; Lagae, Lieven; Lambrechts, Danielle A.J.E.; Braakman, Hilde M. H.; Majoie, Marian

doi:10.1007/s00381-020-04578-7

Cited by 72 publications

(75 citation statements)

References 49 publications

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“…The authors identified five RCTs for a total of 472 patients recruited. 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: 64%

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: 64%

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

Verrotti¹,

Iapadre²,

Francesco³

et al. 2020

Nutrients

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“…Ketogenic diet has a significant efficacy in refractory epilepsy [51]. One of the hypotheses regarding mechanism of action of TSC epilepsy is through the AMP-activated kinase (AMPK) pathway [21]; tuberin is phosphorylated by AMPK in response to certain stresses, (starvation caused by KD in this case).…”

Section: Ketogenic Dietmentioning

confidence: 99%

Medical treatment of tuberous sclerosis-related epilepsy

et al. 2020

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Epilepsy is one of the most frequent CNS manifestations of tuberous sclerosis, and for most patients, it is the major debilitating factor. In up to 70% of the cases, the epilepsy is refractory and usually associated with significant behavioral as well as developmental consequences. Therefore, controlling seizures is one of the biggest medical and surgical challenges. Understanding the cellular mechanism involved in the disease empowered targeted research aimed toward early intervention in the epileptogenicity process. In this review, we present an update on the pharmacological treatments in tuberous sclerosisrelated epilepsy.

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“…6,7 A recent meta-analysis of five randomized controlled trials revealed that 35-56.1% of patients on a KD achieved a >50% reduction in seizures without severe adverse effects. 8 Nevertheless, the use of DT for refractory epilepsy is restricted by its poor tolerability, insufficient feasibility for caregivers (due to diet complexity), and relatively poor compliance. 9 Diet maintenance is especially difficult in patients who do not experience definitive seizure reduction after DT.…”

Section: Introductionmentioning

confidence: 99%

The Early Response to Dietary Therapy can Predict the Late Outcome in Children with Intractable Epilepsy

et al. 2021

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Background and Purpose Dietary therapy (DT), including the ketogenic diet (KD), is one of the nonpharmacological treatment options for patient with drug-resistant epilepsy. However, maintaining DT in patients without seizure reduction is very difficult, so it is critical for clinicians to decide when to stop this intervention. Methods We retrospectively analyzed early clinical and laboratory findings and the clinical characteristics of children who received DT. The maintenance of DT and the clinical seizure frequency were assessed at 1, 3, 6, 12, and 24 months after KD initiation. Responders were defined as patients showing an overall reduction in seizure frequency of >50% relative to the baseline. Results We included 67 patients who received DT, but only 23 (34.3%) of these patients remained on DT at 6 months. Only 1 (5%) of the 20 responders at 1 month became a nonresponder at 6 months. The response rate at 6 months was significantly higher among patients under 2 years of age (15/17, 88.2%) than older patients (2/6, 33.3%; p =0.021). Moreover, the 6-month responders were significantly younger (29.4±38.6 months, mean±SD) than the nonresponders (98.9±84.6 months, p =0.012) at the initiation of the diet. A high blood β-hydroxybutyrate (BHB) level at 1 month predicted a good DT response at 6 months. Conclusions Most 1-month responders maintained their response on DT for up to 6 months. The blood BHB level at 1 month was significantly correlated with the 6-month seizure outcome. Confirming clinical and laboratory biomarkers for the efficacy of DT requires further studies with larger cohorts.

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Ketogenic diet for the treatment of pediatric epilepsy: review and meta-analysis

Cited by 72 publications

References 49 publications

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

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

Medical treatment of tuberous sclerosis-related epilepsy

The Early Response to Dietary Therapy can Predict the Late Outcome in Children with Intractable Epilepsy

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