Ketogenic diets for drug-resistant epilepsy

Area of Science:

• Neurology
• Dietary Science
• Clinical Research

Background:

• Ketogenic diets (KDs), characterized by high fat and low carbohydrate content, are explored for their potential to reduce seizure frequency in epilepsy.
• This review is an update of previous research, focusing on the efficacy of KDs in drug-resistant epilepsy, particularly in children.

Purpose of the Study:

• To assess the effectiveness of ketogenic diets in managing drug-resistant epilepsy across all age groups.
• To evaluate seizure control, adverse effects, and other outcomes associated with KD interventions.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Searched major databases including Cochrane Register of Studies and MEDLINE up to April 2019.
• Included studies involving individuals of any age with drug-resistant epilepsy, assessing seizure freedom, reduction, adverse events, and quality of life.

Main Results:

• Ketogenic diets showed potential for seizure reduction in children with drug-resistant epilepsy, though evidence quality was low to very low.
• In adults, evidence for KD effectiveness in reducing seizures was very uncertain, with no participants achieving seizure freedom in one analysis.
• Common adverse effects across studies included gastrointestinal issues like vomiting, constipation, and diarrhea, with varying certainty.

Conclusions:

• Ketogenic diets may be effective for children with drug-resistant epilepsy, but their use in adults remains uncertain due to limited, low-quality evidence.
• Related diets like the Modified Atkins Diet (MAD) may offer similar seizure control with potentially fewer side effects, warranting further investigation.
• Ketogenic diets remain a viable option for individuals with drug-resistant epilepsy, especially those unsuitable for surgery, but more research, particularly in adults, is crucial.