<p>Current Perspectives On The Role Of The Ketogenic Diet In Epilepsy Management</p>

Abstract

Drug-refractory epilepsy is a commonly prevalent pediatric neurological illness of global significance. Ketogenic diet (KD) is a time-tested therapeutic modality for refractory epilepsy, which has reemerged as a robust alternative to anti-epileptic pharmacotherapy. There is a growing body of evidence which supports the anti-seizure efficacy, safety profile and feasibility of KD use in childhood epilepsy. In addition, this modality has been recognized to reduce anti-epileptic exposure, improve cognition and behavioral profile of patients as well as improve the quality-of-life of care-givers. Current indications of KD include refractory epilepsy syndromes, selected metabolic disorders (such as pyruvate dehydrogenase deficiency) and a host of varied neurological entities. KD research has broadened the knowledge-base about its mechanisms of action. Four types of KD are in vogue currently with varying nutritional constitution, palatability, administration protocols and comparable efficacy. KD initiation and maintenance are the result of concerted effort of a team of pediatric neurologist/epileptologist, nutritionist and patient’s primary care-giver. Consensus is being formulated about various practical aspects of KD such as patient-selection, parental counseling, baseline work-up, dietary prescription, nutritional supplementation, concurrent anti-epileptic drug administration, follow-up and treatment-duration. Novel applications of KD include its use in neonatal epilepsy and super-refractory status epilepticus and tailor-made formulations such as cooking oil-based KD in predominantly rice-fed populations. Increasing body of clinical experience, improved nutritional designs and translational research are promoting KD as a major therapeutic modality. Currently, KD forms a core essence in the armamentarium against refractory epilepsy. In this review, we summarize the recent advances and current perspectives in the use of KD in refractory epilepsy.

Evaluation of E-Health Applications for Paediatric Patients with Refractory Epilepsy and Maintained on Ketogenic Diet

“…Then, a correct management of the ketogenic diet is also important to avoid side effects [ 16 , 17 , 19 ], controversies [ 29 ], and, in some cases, a phenomenon known as the rebound effect [ 30 ], which is characterised by a paradoxical seizure worsening [ 31 ]. Thus, the initiation and maintenance of the dietary treatment are the result of concomitant efforts of paediatric neurologists/epileptologists, dieticians, families and other patients’ caregivers [ 32 ].…”

Possible interplay between the theories of pharmacoresistant epilepsy

“…Similarly, individuals with bilateral onset of habitual seizures, chronic central nervous system disorders, and idiopathic generalized seizures do not qualify for surgery (Anyanwu & Motamedi, 2018; Miller & Hakimian, 2013). As a management alternative, patients with PRE who do not qualify for resective surgery are often instructed to follow a classic ketogenic diet or one of its variants, such as the medium‐chain triglyceride ketogenic diet, modified Atkins diet, or low glycemic index ketogenic diet (Goswami & Sharma, 2019). Due to its unappetizing and restrictive characteristics, the ketogenic diet is often discontinued by patients (D’Andrea Meira et al., 2019).…”

“…Due to its unappetizing and restrictive characteristics, the ketogenic diet is often discontinued by patients (D’Andrea Meira et al., 2019). This diet is also harmful to patients with metabolic disorders encompassing impaired gluconeogenesis (Goswami & Sharma, 2019). Studies have also shown deleterious effects of this diet on the gastrointestinal (Kossoff et al., 2018; Lin et al., 2017), skeletal (Bergqvist et al., 2008; Simm et al., 2017), cardiovascular (Bank et al., 2008), and renal systems (Choi et al., 2010; Sampath et al., 2007).…”

The Ketogenic Diet Revisited: Beyond Ketones

“…Nevertheless, there are barriers and disadvantages in putting the KD into practice, such as palatability issues, compliance issues, side effects (usually mild), variable response rates, and restrictions to the daily life of the patient (15). Overall, a multidisciplinary team (pediatric neurologist, dietician/nutritionist, and a primary care-giver) is indispensable when dietary treatments are initiated and also during maintenance (16).…”