The place of a ketogenic diet in the treatment of resistant epilepsy: a comprehensive review

Cicek, Ebru; Şanlıer, Nevin

doi:10.1080/1028415x.2022.2095819

Cited by 10 publications

(9 citation statements)

References 81 publications

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“…The classic ketogenic diet, including high fat, adequate protein, and low carbohydrate content, thereby mimicking fasting, offers a treatment for refractory epilepsy. 64 Less rigid ketogenic diets have been used to achieve weight loss and/or glycemic control, which are not the focus of this section. Fats, rather than carbohydrates, are used as the primary energy source.…”

Section: Ketogenic Dietmentioning

confidence: 99%

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Pediatric formulas: Categories, composition, and considerations

et al. 2023

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Formulas, liquid nutrition, may be consumed orally or via a feeding tube to provide partial or complete nutrition that a given individual could not obtain using natural food stuffs in their native form. A wide range of commercially available formulas exist, which may be used as sole-source nutrition or in conjunction with other foods. Physicians and dietitians must understand the nature of and indications for specific formulas to treat diseases, provide complete nutrition to patients, and avoid harm. Products vary in macronutrient and micronutrient content and calorie concentration among many other factors. They are formulated specifically for patients of specific ages, correlating to nutritional needs and medical diagnoses. Additionally, formula availability, insurance coverage, mode of consumption, physiologic tolerance, and caregiver preference influence formula selection. Caregivers may also make their own pediatric formulas. We review commercial and homemade pediatric formulas.

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Section: Ketogenic Dietmentioning

confidence: 99%

“…Ketogenic diets use fat to carbohydrate plus protein gram ratios ranging from 4:1 (90% of calories from fat) to 2:1 (82% of calories from fat). 8,64,65 Nutritionally complete commercial formulas come in ratios of 4:1 and 3:1. Historically, ketogenic formulas are milk-or plant-based with either intact protein or peptide.…”

Section: Ketogenic Dietmentioning

confidence: 99%

Pediatric formulas: Categories, composition, and considerations

et al. 2023

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“…For a century now, the ketogenic diet (KD) has been employed as a therapeutic approach for managing epilepsy. This dietary regimen is characterized by its high-fat content, low-carbohydrate intake, and sufficient level of protein to support growth, effectively replicating the metabolic changes that occur during periods of starvation [ 1 - 2 ].…”

Section: Introductionmentioning

confidence: 99%

Keto Clarity: A Comprehensive Systematic Review Exploring the Efficacy, Safety, and Mechanisms of Ketogenic Diet in Pediatric Epilepsy

Faheem,

Jaiswal,

Shergill

et al. 2024

Cureus

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Epilepsy, a widespread neurological disorder characterized by recurrent seizures, affects millions globally, with a significant impact on the pediatric population. Antiepileptic drugs (AEDs) constitute the primary treatment; however, drug-resistant epilepsy (DRE), especially in children, poses a therapeutic challenge. Alternative interventions, such as surgery, vagus nerve stimulation, and the ketogenic diet (KD), have been explored. This systematic review aims to investigate various types of KDs, their distinctions, their effectiveness, and their safety concerning the reduction of seizure frequency, achieving seizure freedom, and the occurrence of adverse events. The study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was conducted using databases such as PubMed Central (PMC), MedLine, and Science Direct to identify relevant articles. Eligibility criteria and quality assessment tools were applied to evaluate the potential risk of bias and select 11 articles for inclusion in this review. The selected articles encompassed four randomized controlled trials (RCTs), two systematic reviews, and five narrative reviews. The data collected for this review was completed on October 2, 2023. Challenges, such as palatability, cultural factors, and adherence difficulties, were identified. Family or caregiver involvement plays a pivotal role in treatment success. Despite numerous RCTs and reviews, information gaps persist, hindering conclusive outcomes. Evaluating the risk-benefit ratio is crucial, considering potential side effects. The highly individualized nature of KD therapy, influenced by diverse seizure types and syndromes, necessitates a trial-and-error approach monitored by a multidisciplinary team. Long-term safety and efficacy demand continuous real-life patient data review. In summary, while KD presents a promising alternative for DRE, its success relies on meticulous planning, individualized implementation, and ongoing research to address existing challenges and information gaps.

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“…The use of ketone bodies to treat neurological disorders has been shown in early studies using the ketogenic diet and exogenous ketone administration for the treatment of epilepsy 14 . The proposed mechanism of action in reducing seizure occurrence is attributed to the role of BHB as a signalling molecule, binding to receptors on transporters responsible for neuronal excitability and regulating ϒ‐amino butyric acid (GABA) levels 15–17 …”

Section: Introductionmentioning

confidence: 99%

“…14 The proposed mechanism of action in reducing seizure occurrence is attributed to the role of BHB as a signalling molecule, binding to receptors on transporters responsible for neuronal excitability and regulating Υ-amino butyric acid (GABA) levels. [15][16][17] Oxidative cerebral metabolism and TCA flux (V TCA ) are responsible for synthesizing energy-rich molecules such as NADH, FADH 2 , and GTP and show a strong linear correlation with brain activity. V TCA can be measured in vivo through metabolic fate studies with labeled precursors, e.g., labeled glucose.…”

Section: Introductionmentioning

confidence: 99%

In vivo assessment of β‐hydroxybutyrate metabolism in mouse brain using deuterium (²H) MRS

Soni

Swain

Jacobs

et al. 2023

Magnetic Resonance in Med

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To monitor the metabolic turnover of β-hydroxybutyrate (BHB) oxidation using 2 H-MRS in conjunction with intravenous administration of 2 H labeled BHB.Methods: Nine-month-old mice were infused with [3,4,4,4]-2 H 4 -BHB (d 4 -BHB; 3.11 g/kg) through the tail vein using a bolus variable infusion rate for a period of 90 min. The labeling of downstream cerebral metabolites from the oxidative metabolism of d 4 -BHB was monitored using 2 H-MRS spectra acquired with a home-built 2 H surface coil on a 9.4T preclinical MR scanner with a temporal resolution of 6.25 min. An exponential model was fit to the BHB and glutamate/glutamine (Glx) turnover curves to determine rate constants of metabolite turnover and to aid in the visualization of metabolite time courses.Results: Deuterium label was incorporated into Glx from BHB metabolism through the tricarboxylic acid (TCA) cycle, with an increase in the level of [4,4]-2 H 2 -Glx (d 2 -Glx) over time and reaching a quasi-steady state concentration of ∼0.6 ± 0.1 mM following 30 min of infusion. Complete oxidative metabolic breakdown of d 4 -BHB also resulted in the formation of semi-heavy water (HDO), with a four-fold (10.1 to ∼42.1 ± 7.3 mM) linear (R 2 = 0.998) increase in its concentration by the end of infusion. The rate constant of Glx turnover from d 4 -BHB metabolism was determined to be 0.034 ± 0.004 min −1 . Conclusion: 2 H-MRS can be used to monitor the cerebral metabolism of BHB with its deuterated form by measuring the downstream labeling of Glx. The integration of 2 H-MRS with deuterated BHB substrate provides an alternative and clinically promising MRS tool to detect neurometabolic fluxes in healthy and disease conditions. K E Y W O R D S2 H-MRS, brain, d 4 -BHB, ketone bodies, metabolism, TCA

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The place of a ketogenic diet in the treatment of resistant epilepsy: a comprehensive review

Cited by 10 publications

References 81 publications

Pediatric formulas: Categories, composition, and considerations

Pediatric formulas: Categories, composition, and considerations

Keto Clarity: A Comprehensive Systematic Review Exploring the Efficacy, Safety, and Mechanisms of Ketogenic Diet in Pediatric Epilepsy

In vivo assessment of β‐hydroxybutyrate metabolism in mouse brain using deuterium (²H) MRS

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The place of a ketogenic diet in the treatment of resistant epilepsy: a comprehensive review

Cited by 10 publications

References 81 publications

Pediatric formulas: Categories, composition, and considerations

Pediatric formulas: Categories, composition, and considerations

Keto Clarity: A Comprehensive Systematic Review Exploring the Efficacy, Safety, and Mechanisms of Ketogenic Diet in Pediatric Epilepsy

In vivo assessment of β‐hydroxybutyrate metabolism in mouse brain using deuterium (2H) MRS

Contact Info

Product

Resources

About

In vivo assessment of β‐hydroxybutyrate metabolism in mouse brain using deuterium (²H) MRS