Ketogenic Diet and Epilepsy: What we know so far

D.Sc. (Doctorate in Neurology - USA), D.Sc. (Doctorate in Medicine - India), FRCP (Glasgow), FRCP (Ireland), FAAN (USA), FACP (Philadelphia) FRSTM&H (London), FANA (USA), FIMSA (UK), FIAMS (India), FIACM (India), DM (Neurology), MD (Medicine), MBBS

Epilepsy is a disabling and common neurological disease, which can be controlled successfully with one or more antiepileptic drugs. Some of these patients are not well respond to drug treatment, so it is necessary to search for alternative treatments for epilepsy such as palliative surgery, neuromodulation, and a ketogenic diet (KD). The ketogenic diet consists of a high-fat and low-protein and carbohydrate diet, with restricted calories and fluids. The diet mimics the fasting state, altering the metabolism to use fats as a primary fuel source; catabolism of fatty acids in the liver produces ketone bodies (KB), which induces urinary ketosis. According to a review, the keto diet appears to reduce or prevent seizures in children and adults with drug resistant or refractory epilepsy. The Epilepsy Foundation recommends the diet as a potential treatment for refractory epilepsy.

Epilepsy is a metabolic disease, and one theory is that the keto diet works by altering a person’s metabolism. Neurons, or hyperexcitable nerve cells, in the brain may contribute to the onset of seizures. The keto diet leads to metabolic changes in the blood and cerebrospinal fluid, and these changes, along with other factors, may decrease the excitability of neurons. This could have a stabilizing effect on seizures.

Children

Children of any age can follow a keto diet. Under the strict supervision of a doctor, only keto diet may help control seizures in infants. Up to 60% of children who try a supervised ketogenic diet experience 50% or greater reduction in seizure frequency.

Adolescents and Adults

Doctors often do not recommend the classic keto diet to adolescents and adults because it can be difficult to maintain. They may instead recommend a modified keto diet that is more palatable and convenient. Experts suggest that around 30–40% of adults with epilepsy who follow a keto diet experience at least a 50% reduction in seizures. However, fewer than 10% of these adults achieve a 90% reduction in seizures or stop experiencing them.

The doctor usually sees the child every 1 to 3 months. Blood and urine tests need to be performed to make sure there are no medical problems. The height and weight are measured to see if growth has slowed down. If seizures have been well controlled for some time, usually 2 years, the doctor might suggest going off the diet. However, in many situations, the diet has led to significant, but not total, seizure control. Families may choose to remain on the ketogenic diet for many years in these situations.

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