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Is ketogenic diet a 'precision medicine'? Recent developments and future challenges.

Raffaele Falsaperla1, Vincenzo Sortino2, Pasquale Striano3

  • 1Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy; Unit of Pediatrics and Pediatric Emergency, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", San Marco Hospital, Catania, Italy.

European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society
|November 20, 2023
PubMed
Summary

The ketogenic diet is a standard treatment for GLUT1 deficiency epilepsy and a potential option for drug-resistant epilepsy. Its role as precision medicine in other epilepsies requires further investigation into its neuroprotective mechanisms.

Keywords:
Drug-resistant epilepsyGLUT-1Ketogenic dietPrecision medicineTranscriptomic profile

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Area of Science:

  • Neurology
  • Metabolic Disorders
  • Precision Medicine

Background:

  • Precision medicine is increasingly relevant in epilepsy management.
  • The ketogenic diet is a standard treatment for GLUT1 deficiency and a NICE-recommended option for drug-resistant epilepsy.
  • Its precise role as a precision medicine tool across all epilepsy types is under investigation.

Purpose of the Study:

  • To evaluate the ketogenic diet's classification as precision medicine in epilepsy treatment.
  • To explore the hypothesized mechanisms of ketogenic diet efficacy in various epilepsy types.
  • To emphasize the importance of early, well-selected ketogenic diet initiation for improved patient outcomes.

Main Methods:

  • Review of current clinical guidelines and research on ketogenic diet in epilepsy.
  • Hypothesizing underlying genetic, epigenetic, neuroprotective, neuromodulatory, and anti-neuroinflammatory mechanisms.
  • Highlighting the need for large-scale, multicentric studies and omics-based approaches.

Main Results:

  • Ketogenic diet is established as precision medicine for GLUT1 deficiency.
  • Efficacy in other epilepsies is hypothesized via neuroprotection and reduced neuroinflammation.
  • Early intervention in well-selected patients may improve quality of life and reduce comorbidities.

Conclusions:

  • The ketogenic diet's application as precision medicine varies across epilepsy types.
  • Further research is needed to elucidate mechanisms and optimize its use.
  • Omics technologies and collaborative efforts are crucial for advancing personalized epilepsy treatment.