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How can a ketogenic diet improve seizure control in persons with epilepsy?
The ketogenic diet is a dietary regimen characterized by a high lipid content and reduced carbohydrate and protein intake.
The ketogenic diet is a dietary regimen characterized by a high lipid content and reduced carbohydrate and protein intake. It can mimic the metabolic profile induced by fasting through a decrease in blood glucose levels.1
In vivo studies have shown that the ketogenic diet can be used to modify the gut microbiota. The resulting increase in GABA* levels will attenuate the neuronal excitability, leading to a reduction of seizures.1
But there is more. The antiseizure efficacy might depend on the use of fatty acids instead of carbohydrates as an energy substrate, resulting in a reduction of free oxygen radicals and an increase in energy substrates such as ATP, creatinine and phosphocreatine, which could contribute to neuronal stability.2
What are the clinical indications and main complications of the ketogenic diet?
The ketogenic diet is particularly effective in children, but can also be useful in adults. It is considered the treatment of choice in specific metabolism-based epilepsy syndromes, with proven efficacy in more than 80% of cases, especially when the condition is diagnosed and treated early.2
The ketogenic diet has been shown to reduce seizure frequency by at least 50% after 6 months in 30-60% of children and adolescents with drug-resistant epilepsy.1
However, it is important that this diet is initiated in a hospital setting because of the possible metabolic complications that may occur when starting treatment.1
In general, the ketogenic diet is well tolerated by the majority of patients. However, both short-term and long-term side effects may occur, including gastrointestinal disorders, hyperlipidaemia, hyperuricemia, drowsiness, infections and protein deficiency.2
For how long should a ketogenic diet be followed?
The diet should be followed for a limited time. Remission of the seizures will determine its duration.3
The ketogenic diet is not suitable for all persons with epilepsy as a dietary therapy.3 Those who follow this diet must undergo regular check-ups at a specialist centre, and be monitored by a team of epileptologists, dieticians, and specialist nurses.2 They must also adhere to the provided instructions, including regular laboratory checks.
What are the main limitations to its use in Italy?
The ketogenic diet is still not widely used in epileptology in Italy today.4 Some of the reasons for its limited uptake and therapeutic potential are:
Due to the possible occurrence of short- and long-term side effects as well as the limited evidence available, the indication to follow a ketogenic diet remains a purely medical matter.3
NOTES
*GABA (gamma-aminobutyric acid) is the body's primary inhibitory neurotransmitter. Its function is to limit the electrical activity of neurons, countering the opposite effect of excitatory neurotransmitters. In persons with epilepsy, neurons have heightened excitability, which facilitates the onset and intensification of epileptic seizures.5
**In medicine, the term compliance describes the degree to which a patient correctly follows medical advice and prescriptions, whether pharmacological or non-pharmacological (dietary, lifestyle, periodic follow-up examinations, etc.).6
- Serra G, et al. Dieta chetogenica: una guida per il pediatra. AreaPed 2022;23(3):118-123.
- https://www.lice.it/pdf/Libro_bianco.pdf
- https://www.fondazioneveronesi.it/magazine/articoli/neuroscienze/epilessia-in-quali-casi-puo-essere-utile-la-dieta-chetogenica
- lice.it/pdf/web_2023_guida_alle_epilessie.pdf
- https://www.quotidianosanita.it/scienza-e farmaci/articolo.php?articolo_id=60697
- https://www.doctoros.it/rubriche/psicologia/compliance-del-paziente/
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