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Ketogenic diet –  ef­fective treatment of childhood and adolescent epilepsies


Authors: O. Horák
Authors‘ workplace: Klinika dětské neurologie LF MU a FN Brno Centrum pro epilepsie Brno
Published in: Cesk Slov Neurol N 2019; 82(1): 8-14
Category: Minimonography
doi: https://doi.org/10.14735/amcsnn20198

Overview

Ketogenic diet has been established in the treatment of epilepsy for almost 100 years. It is ir­replaceable in paediatric epileptology, especial­ly in the treatment of myoclonic-atonic epilepsy, mak­­ing it the most ef­fective therapeutic option. With grow­­ing knowledge and implementation of the modified Atkins diet and the low glycaemic index treatment in clinical practice, the usage of ketother­apy, which is an umbrel­la term for all dietary regimes based on carbohydrate restriction and fat surplus, has been extended to all age brackets of epilepsy patients. Nevertheles­s, it is still a highly-selective ther­apy, specified for an exclusive circle of patients with perfect compliance, which is fundamental for clinical succes­s. This work aims to provide an overview of cur­rent knowledge in the field of ketother­apy and to provide clinicians with the insight into the important practical aspects of its management.

Key words:

ketotherapy – ketogenic – diet – intractable epilepsy

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Guelpa G, Marie A. La lutte contre l`epilepsie par la desintoxication et par la reducation alimentaire. Rev Ther Medico-Chirurgicale 1911; 78: 8– 13.
2. Geyelin HR. Fast­­ing as a method for treat­­ing epilepsy. Medical Record 1921; 99: 1037– 1039.
3. Conklin HW. Cause and treatment of epilepsy. J Am Osteopath As­soc 1922; 26: 11– 14.
4. Woodyatt RT. Objects and method of diet adjustment in diabetes. Arch Intern Med 1921; 38(2): 125– 141.
5. Wilder RM. The ef­fect of ketonemia on the course of epilepsy. Mayo Clin Proc 1921; 2: 307.
6. Wilder RM. High fat diets in epilepsy. Mayo Clin Proc 1921; 2: 308.
7. Huttenlocher PR, Wilbourne AJ, Sigmore JM. Medium chain triglycerides as a ther­apy for intractable childhood epilepsy. Neurology 1921; 21(11): 536– 540.
8. Neal EG, Chaf­fe HM, Schwartz R et al. A randomised trial of clas­sical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia 2009; 50(5): 1109– 1117. doi: 10.1111/ j.1528-1167.2008.01870.x.
9. Kos­soff EH, Rowley H, Sinha SR et al. A prospective study of the modified Atkins diet for intractable epilepsy in adults. Epilepsia 2008; 49(2): 316– 319. doi: 10.1111/ j.1528-1167.2007.01256.x.
10. Kos­soff EH, Bosarge JL, Miranda MJ et al. Will seizure controle improve by switch­­ing the modified Atkins diet to the traditional ketogenic diet? Epilepsia 2010; 51(12): 2496– 2499. doi: 10.1111/ j.1528-1167.2010.02774.x.
11. Pfeifer HH, Thiele EA. Low-glycaemic index treat­ment: a liberalized ketogenic diet for treatment of intractable epilepsy. Neurology 2005; 65(11): 1810– 1812. doi: 10.1212/ 01.wnl.0000187071.24292.9e.
12. Kos­soff EH, Zupec-Kania BA, Auvin S et al. Optimal clinical management of children receiv­­ing dietary ther­apies for epilepsy: Updated recom­mendations of the International Ketogenic Diet Study Group. Epilepsia Open 2018; 3(2): 175– 192. doi: 10.1002/ epi4.12225.
13. Wolover T, Jenkins D. Ef­fect of dietary fiber and foods on carbohydrate metabolism. In: Spil­ler G (ed). Handbook of dietary fiber in human nutrition. 3rd ed. Boca Raton, FL: CRP Press 2001: 321– 362.
14. Brand-Mil­ler J, Holt S. Test­­ing the glycaemic index of foods: in vivo, not in vitro. Eur J Clin Nutr 2004; 58(4): 700– 701. doi: 10.1038/ sj.ejcn.1601856.
15. Hartman AL, Rho JM. The bio­chemical basis of dietary ther­apies for neurological disorders. In: Neal E (ed). Dietary treatment of epilepsy. Chichester: John Wiley and Sons, Ltd 2012: 34– 44.
16. Rho JM. How does the ketogenic diet induce anti-seizure ef­fects? Neurosci Lett 2017; 10(637): 4– 10. doi: 10.1016/ j.neulet.2015.07.034.
17. Rho JM, Anderson GD, Donevan SD et al.Acetoacetate, acetone and dibenzylamine (a concom­itant in 1-(+)-beta-hydroxybutyrate) exhibit direct anticonvulsant actions in vivo. Epilepsia 2002; 43(4): 358– 361.
18. Thio LL, Wong M, Yamada KA. Ketone bodies do not directly alter excitatory or inhibitory hippocampal synaptic transmis­sion. Neurology 2000; 54: 325-331. doi: 10.1212/ wnl.54.2.325
19. McDaniel SS, Rens­­ing NR, Thio LL et al. The ketogenic diet inhibits the mam­malian terget of rapamycin (mTOR) pathway. Epilepsia 2011; 52(3): e7– e11. doi: 10.1111/ j.1528-1167.2011.02981.x.
20. Yudkoff M, Daikhin Y, Horyn O et al. Ketosis and brain handl­­ing of glutamate, glutamine, and GABA. Epilepsia 2008; 49 (Suppl 8): 73– 75. doi: 10.1111/ j.1528-1167.2008.01841.x.
21. Has­san-Olive MM, Lauritzen KH, Ali M et al. A ketogenic diet improves mitochondrial bio­genesis and bio­energetics via tha PGC1α-SIRT3-UCP2 Axis. Neurochem Res 2018; [Epub ahead of print]. doi: 10.1007/ s11064-018-2588-6.
22. Gaspard N, Hirsch LJ, Sculier C et al. New-onset refractory status epilepticus (NORSE) and febrile infection-related epilepsy syndrome (FIRES): state of the art and perspectives. Epilepsia 2018; 59(4): 745– 752. doi: 10.1111/ epi.14022.
23. Freeman JM, Vin­­ing EP, Pil­las DJ et al. The ef­ficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children. Pediatrics 1998; 102(6): 1358– 1363.
24. Lefevre F, Aronson N. Ketogenic diet for treatment of refraktory epilepsy in children: a systematic review of ef­ficacy. Pediatrics 2000; 105(4): E46.
25. Bergqvist AG, Schall JI, Gal­lagher PR et al. Fast­­ing versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of ef­ficacy. Epilepsia 2005; 46(11): 1810– 1819. doi: 10.1111/ j.1528-1167.2005.00282.x.
26. Freeman JM, Vin­­ing EP, Kos­soff EH et al. A blind­­ed, cros­sover study of the ef­ficacy of the ketogenic diet. Epilepsia 2009; 50(2): 322– 325. doi: 10.1111/ j.1528-1167.2008.01740.x.
27. Sharma S, Sankhyan N, Gulati S et al. Use of the modified Atkins diet for the treatment of refractory childhood epilepsy: a randomized control­led trial. Epilepsia 2013; 54(3): 481– 486. doi: 10.1111/ epi.12069.
28. Lambrechts DA, de Kinderen RJ, Vles JS et al. A randomized control­led trial of the ketogenic diet in refraktory childhood epilepsy. Acta Neuol Scand 2017; 135(6): 231– 239. doi: 10.1111/ ane.12737.
29. Chen W, Kos­soff EH. Long-term fol­low-up of child­ren treated with the modified Atkins diet. J Child Neurol 2012; 27(6): 754– 758. doi: 10.1177/ 0883073812441062. 
30. Ye F, Li XJ, Jiang WL et al. Ef­ficacy of and patient comp­liance with ketogenic diet in adults with intractable epilepsy: a metaanalysis. J Clin Neuol 2015; 11(1): 26– 31. doi: 10.3988/ jcn.2015.11.1.26.
31. van der Louw E, van den Hurk D, Neal E et al. Ketogenic diet guidelines for infants with refraktory epilepsy. Eur J Paediatr Neurol 2016; 20(6): 798– 809. doi: 10.1016/ j.ejpn.2016.07.009.
32. Buchhalter JR, D`Alfonso S, Con­nol­ly M et al. The relationship between D-beta-hydroxybutyrate blood concentrations and seizure control in children treated with the ketogenic diet for medical­ly intractable epilepsy. Epilepsia Open 2017; 2(3): 317– 321. doi: 10.1002/ epi4.12058.
33. Kos­soff EH, Laux LC, Blackford R et al. When do sei­zures esual­ly improve with the ketogenic diet? Epilepsia 2008; 49(2): 329– 333. doi: 10.1111/ j.1528-1167.2007.01417.x.
34. Martinez CC, Pyzik PL, Kos­soff EH. Discontinu­­ing the ketogenic diet in seizure-free children: recur­rence and risk factors. Epilepsia 2007; 48(1): 187– 190. doi: 10.1111/ j.1528-1167.2006.00911.x.
35. Nizamuddin J, Turner Z, Rubenstein JE et al. Management and risk factors for dyslipidemia with the ketogenic diet. J Child Neurol 2008; 23(7): 758– 761. doi: 10.1177/ 0883073808318061.
36. Güzel O, Yilmaz U, Uysal U et al. The ef­fect of olive oil-based ketogenic diet on serum lipid levels in epileptic children. Neurol Sci 2016; 37(3): 465– 470. doi: 10.1007/ s10072-015-2436-2.
37. Kwiterovich PO Jr, Vin­­ing EP, Pyzik P et al. Ef­fect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA 2003; 290(7): 912– 920. doi: 10.1001/ jama.290.7.912.
38. Groesbeck DK, Bluml RM, Kos­soff EH. Long-term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol 2006; 48(12): 978– 981. doi: 10.1017/ S0012162206002143.
39. Doksöz Ö, Güzel O, Yilmax Ü et al. The short-term ef­fect of ketogenic diet on carotid intima-media thickness and elastic properties of the carotid artery and aorta in epileptic children. J Child Neurol 2015; 30(12): 1646– 1650. doi: 10.1177/ 0883073815576793.
40. Coppola G, Natale F, Torino A et al. The impact of the ketogenic diet on arterial morphology and endothelial function in children and young adults with epilepsy: a case-control study. Seizure 2014; 23(4): 260– 265. doi: 10.1016/ j.seizure.2013.12.002.
41. Sampath A, Kos­soff EH, Furth SL et al. Kidney stones and the ketogenic diet: risk factors and prevention. J Child Neurol 2007; 22(4): 375– 378. doi: 10.1177/ %883073807301926.
42. Furth SL, Casey JC, Pyzik PL et al. Risk factors for urolithiasis in children on the ketogenic diet. Pediatr Nephrol 2000; 15(1– 2): 125– 128.
43. Vin­­ing EP, Pyzik P, McGrogan J et al. Growth of child­ren on the ketogenic diet. Dev Med Child Neurol 2002; 44(12): 796– 802. doi: 10.1111/ j.1469-8749.2002.tb00769.x.
44. Stewart WA, Gordon K, Camfield P. Acute pan­creatitis caus­­ing death in a child on the ketogenic diet. J Child Neurol 2001; 16(9): 682. doi: 10.1177/ 08830738010 1600910.
45. Best TH, Franz DN, Gilbert DL et al. Cardiac complications in pediatric patients on the ketogenic diet. Neurology 2000; 54(12): 2328– 2330. doi: 10.1212/ WNL.54.12.2328.

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Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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