Ketogenic diets for drug-resistant epilepsy

Martin‐McGill, Kirsty J; Jackson, Cerian F; Bresnahan, Rebecca; Levy, Robert G; Cooper, Paul

doi:10.1002/14651858.cd001903.pub4

Cited by 165 publications

(218 citation statements)

References 43 publications

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“…Semistarvation ketogenic diets containing <800 kcal are primarily used therapeutically in the treatment of modest to severe obesity to produce a rapid and safe weight loss that largely spares lean tissue during the weight loss phase . Eucaloric ketogenic diets that meet energy requirements to allow for growth in children have long been used successfully for the management of drug‐resistant epilepsy . They have more recently been used for their putative benefits in competitive sports and in the management of type 2 diabetes in overweight and obese individuals .…”

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confidence: 99%

“…The increasing clinical use of eucaloric ketogenic diets for purposes of improved control of epilepsy and management of type 1 diabetes in the young and type 2 diabetes in the obese has reawakened interest in the possible unique metabolic consequences which could influence energy balance with very low carbohydrate intake that allows substantial ketonemia. Paramount among these considerations would be the differential effects of sustained ketogenesis and ketonemia on the 2 principal components of the energy balance equation: those affecting energy intake and particularly those impacting energy expenditure.…”

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confidence: 99%

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Some Musings About Differential Energy Metabolism With Ketogenic Diets

Bistrian

2019

J Parenter Enteral Nutr

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Ketogenic states are of 3 major types: total starvation and those resulting from the consumption of semistarvation, ketogenic diets, and eucaloric ketogenic diets. All are characterized by little or no dietary carbohydrate, resulting in a fat‐based metabolism with sustained ketonemia of varying degrees in each state. The latter 2 diets are clinically useful with important impacts on both aspects of the energy balance equation with increased satiety and less hunger on the intake side and probably increased energy expenditure on the output side; both may have important implications for the successful long‐term management of obesity. Consideration of older research regarding the hormonal response to carbohydrate‐free dieting and recent findings on hepatic glycogen status that occurs with sustained ketonemia support the likelihood that there are profound differences in 24‐hour gluconeogenesis rates between ketogenic diets and balanced diets containing substantial carbohydrate. This metabolic distinction could have a meaningful impact to increase the thermic effect of feeding and daily energy expenditure amounting to 100 kcal/d or more with each of the ketogenic diets.

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Some Musings About Differential Energy Metabolism With Ketogenic Diets

Bistrian

2019

J Parenter Enteral Nutr

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“…Ketogenic diets (KDs) are high‐fat, low‐carbohydrate, and moderate‐protein diets used as a treatment option for drug‐resistant epilepsy. KDs are the treatment of choice for neurometabolic disorders such as glucose transport type 1 deficiency syndrome and pyruvate dehydrogenase deficiency and are effective in reducing seizure frequency in approximately one third of patients with epilepsy …”

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confidence: 99%

Biochemical assessment of patients following ketogenic diets for epilepsy: Current practice in the UK and Ireland

et al. 2019

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Objective Biochemical assessment is recommended for patients prior to initiating and following a ketogenic diet (KD). There is no published literature regarding current practice in the UK and Ireland. We aimed to explore practice in comparison with international guidelines, determine approximate costs of biochemical testing in KD patients across the UK and Ireland, and promote greater consistency in KD services nationally. Methods A survey was designed to determine the biochemical tests requested for patients at baseline, 3, 6, 12, 18, and 24 months + on KD. The survey was circulated to 39 centers across the UK and Ireland. Results Sixteen centers completed the survey. Full blood count, electrolytes, calcium, liver function tests (LFTs), lipid profile, and vitamin D were requested at all centers at baseline, in keeping with international guidelines. Bicarbonate, total protein, and urinalysis were less consistently requested. Magnesium and zinc were requested by all centers, despite not being specifically recommended for pre‐diet evaluation in guidelines. Urea and electrolyte profiles and some LFTs were consistently requested at follow‐up, in accordance with guidelines. Other LFTs and renal tests, full blood count, lipid profile, acylcarnitine profile, selenium, vitamin D, and urinalysis were less consistently requested at follow‐up. The mean costs of the lowest and highest number of tests requested at baseline in our participating centers were £167.54 and £501.93; the mean costs of the lowest and highest number of tests requested at 3‐month follow‐up were £19.17 and £450.06. Significance Biochemical monitoring of KD patients varies widely across the UK and Ireland and does not fully correspond to international best practice guidelines. With an ongoing drive for cost‐effectiveness within health care, further work is needed to streamline practice while ensuring patient safety.

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“…1,2 The rationale behind the latter concept stems from recognition that the ketogenic diet works very quickly, has no obvious drug interactions, and can be provided relatively easily in intensive care settings via nasogastric tubes. Two of the fastest growing new indications are the use of the ketogenic diet in infancy and as a treatment for super-refractory status epilepticus.…”

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“…1 In a ketogenic diet, circulating ketone bodies increase the acidic milieu of the body and thus, the risk of metabolic acidosis, with the potential consequences of nephrolithiasis, nephrocalcinosis, and bone mineral density loss. Yet it is by no means definitive, and more patients as well as prospective trials are required in order to guide this unique method of providing ketogenic therapy.…”

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Intravenous ketogenic diet: guidelines for ketogenic parenteral therapy

Kossoff

2019

Develop Med Child Neuro

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This commentary is on the clinical practice guide by van der Louw et al. on pages 48-56 of this issue. REFERENCES 1. van der Louw E, van den Hurk D, Neal E, et al. Ketogenic diet guidelines for infants with refractory epilepsy. Eur J Paediatr Neurol 2016; 20: 798-809. 2. Arya R, Peariso K, Ga ınza-Lein M, et al. Efficacy and safety of ketogenic diet for treatment of pediatric convulsive refractory status epilepticus. Epilepsy Res 2018; 144: 1-6. 3. Rosenthal E, Weissman B, Kyllonen K. Use of parenteral medium-chain triglyceride emulsion for maintaining seizure control in a 5-year-old girl with intractable diarrhea. JPEN J Parenter Enteral Nutr 1990; 14: 543-5. 4. van der Louw E, Aldaz V, Harvey J, et al. Optimal clinical management of children receiving ketogenic parenteral nutrition: a clinical practice guide. Dev Med Child Neurol 2020; 62: 48-56.Commentaries 7

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Ketogenic diets for drug-resistant epilepsy

Cited by 165 publications

References 43 publications

Some Musings About Differential Energy Metabolism With Ketogenic Diets

Some Musings About Differential Energy Metabolism With Ketogenic Diets

Biochemical assessment of patients following ketogenic diets for epilepsy: Current practice in the UK and Ireland

Intravenous ketogenic diet: guidelines for ketogenic parenteral therapy

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