Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned - PubMed (original) (raw)

Review

Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned

Iwona Maria Zarnowska. Nutrients. 2020.

Abstract

Ketogenic diet (KD) has been used to treat epilepsy for 100 years. It is a high-fat, low-carbohydrate, and sufficient-protein-for-growth diet that mimics the metabolic changes occurring during starvation. Except for classic KD, its modified counterparts, including modified Atkins diet and low-glycemic-index treatment, have gained grounds to increase palatability and adherence. Strong evidence exists that the KD offers protection against seizures in difficult-to-treat epilepsy and possesses long-lasting anti-epileptic activity, improving long-term disease outcome. The KD can also provide symptomatic and disease-modifying activity in a wide range of neurodegenerative diseases. In an era of highly available new anti-seizure medications (ASMs), the challenge of refractory epilepsy has still not been solved. This metabolic therapy is increasingly considered due to unique mechanisms and turns out to be a powerful tool in the hands of a skillful team. Despite decades of extensive research to explain the mechanism of its efficacy, the precise mechanism of action is to date still largely unknown. The key feature of this successful diet is the fact that energy is derived largely from fat but not from carbohydrates. Consequently, fundamental change occurs regarding the method of energy production that causes alterations in numerous biochemical pathways, thus restoring energetic and metabolic homeostasis of the brain. There are barriers during the use of this special and individualized therapy in many clinical settings worldwide. The aim of this review is to revisit the current state of the art of therapeutic application of KD in refractory epilepsy.

Keywords: LGIT; MAD; barriers; ketogenic diet; ketone bodies; ketosis; metabolic treatment; refractory epilepsy.

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Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1

Figure 1

Depiction of liver cytosol metabolism that lead to ketone bodies formation penetrating to the brain (detailed description in the text). Abbreviations: CAT—carnitine-acylcarnitine translocase, LCFA—long-chain fatty acids, MCT—monocarboxylic acid transporter, TCA—tricarboxylic acid.

Figure 2

Figure 2

Differences in primary fuel sources between a typical Western diet and a KD. Visual depiction is taken from practice paper of the Academy of Nutrition and Dietetics [19], KD—Ketogenic diet.

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