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REVIEW PAPER
To treat or not to treat drug-refractory epilepsy by the ketogenic diet? That is the question
1
First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
2
Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
3
Department of Biology and Genetics, Medical University of Lublin, Lublin, Poland
4
Department of Physiopathology, Institute of Rural Health, Lublin, Poland
5
Department of Pathophysiology, Medical University of Lublin, Lublin, Poland
Corresponding author
Ann Agric Environ Med. 2016;23(4):533-536
KEYWORDS
ABSTRACT
Epilepsy is a serious neurologic disorder worldwide which affects about 1% of the population (ca. 50 million people), the highest prevalence occurring in both children and elderly. Apart from idiopathic forms, etiology of the disease involves multiple brain risk factors – the most frequent being cerebrovascular diseases, tumours and traumatic injuries. Several treatment options exist, including, for instance, pharmacotherapy, vagal nerve stimulation or epilepsy surgery. In spite of treatment, about 30% of patients with epilepsy still have seizures and become drug-refractory. This is why other treatment options may be recommended, and ketogenic diet seems a last-chance method, especially in children and adolescents with epilepsy. The diet contains high amounts of fat and low carbohydrates with vitamin supplementation. The elevated concentrations of ketones induced by the diet may result in inhibition of the synaptic activity of glutamate, the mammalian target of the rapamycin pathway, and activation of adenosine triphosphate-sensitive potassium channels. One of the main ketones is acetone, shown to increase the seizure threshold and potentiate the anticonvulsant activity of some antiepileptic drugs. The clinical effectiveness of the ketogenic diet has been confirmed in a number of clinical trials carried out mainly on children. A wider use of the ketogenic diet may be limited by the number of early adverse effects (gastrointestinal distress, acidosis, hypoglycaemia, dehydration and lethargy), and late adverse effects (hyperuricaemia, hyperlipidaemia, kidney stones, easy bruising, and decreases in height and weight). Recently, data are available on the negative impact of the ketogenic diet on the qualitative characteristics of lipoprotein subfractions which points to the atherogenic fenotype as a new side-effect. In conclusion, future research directed to the proper identification of patients (in terms of age, epilepsy type and duration, recommended antiepileptic drugs) is necessary to answer the title question.
REFERENCES (41)
1.
Strzelczyk A, Reese J P, Dodel R, Hamer H M. Cost of epilepsy: a systematic review. Pharmacoeconomics 2008; 26(6): 463–476.
2.
de Kinderen R J A, Lambrechts D A J, Wijnen B F M, Postulart D, Aldenkamp A P, Majoie M H, et al. An economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy: An interim analysis. Epilepsia 2016; 57(1): 41–50.
3.
Cramer J A, Wang Z J, Chang E, Copher R, Cherepanov D, Broder M S. Health-care costs and utilization related to long- or short-acting antiepileptic monotherapy use. Epilepsy Behav. 2015; 44: 40–46.
4.
Levy Y, Peleg-Weiss L, Goldberg-Stern H. The modified Atkins diet for intractable epilepsy may be associated with late-onset egg-induced anaphylactic reaction: a case report. Nutrition. 2011; 27(3): 380–382.
5.
Pluta R, Jabłoński M. The ketogenic diet for epilepsy therapy in children: quo vadis? Nutrition 2011;27(5):615–616.
7.
Zupec-Kania BA, Spellman E. An overview of the ketogenic diet for pediatric epilepsy. Nutr Clin Pract 2008;23(6):589–96.
8.
Radzik I, Miziak B, Dudka J, Chrościńska-Krawczyk M, Czuczwar S J. Prospects of epileptogenesis prevention. Pharmacol Rep. 2015; 67(3): 663–668.
9.
Herman S T. Epilepsy after brain insult. Targeting epileptogenesis. Neurology 2002; 59(Suppl 5): S21–S26.
10.
Gitaí D L, Romcy-Pereira R N, Gitaí L L, Leite J P, Garcia-Cairasco N, Paço-Larson M L. Genes and epilepsy I: epilepsy and genetic alterations. Rev Assoc Med Bras. 2008; 54(3): 272–278.
11.
Fisher R S, Acevedo C, Arzimanoglou A, Bogacz A, Cross J H, Elger C E, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014; 55(4): 475–82.
12.
Kwan P, Arzimanoglou A, Berg A T, Brodie M J, Allen Hauser W, Mathern G, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2010; 51(6): 1069–1077.
13.
Kossoff E H, Zupec-Kania B A, Amark P E, Ballaban-Gil K R, Christina Bergqvist A G, Blackford R, et al. Charlie Foundation, Prac tice Committee of the Child Neurology Society; Practice Committee of the Child Neurology Society; International Ketogenic Diet Study Group. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia 2009; 50(2): 304–317.
14.
Brodie M J, Barry S J, Bamagous G A, Norrie J D, Kwan P. Patterns of treatment response in newly diagnosed epilepsy. Neurology 2012; 78(20): 1548–1554.
15.
Sillanpää M, Schmidt D. Natural history of treated childhood-onset epilepsy: prospective, long-term population-based study. Brain 2006; 129(3): 617–624.
16.
Czuczwar S J, Patsalos P N. The new generation of GABA enhancers. Potential in the treatment of epilepsy. CNS Drugs 2001; 15(5): 339–350.
17.
Kossoff E H, McGrogan J R. Worldwide use of the ketogenic diet. Epilep sia 2005; 46(2): 280–289.
18.
Casey J C, McGrogan J, Pillas D, Pyzik P, Freeman J, Vining E P. The implementation and maintenance of the ketogenic diet in children. J Neurosci Nurs. 1999; 31(5): 294–302.
19.
Vehmeijer F O, van der Louw E J, Arts W F, Catsman-Berrevoets C E, Neuteboom R F. Can we predict efficacy of the ketogenic diet in children with refractory epilepsy? Eur J Paediatr Neurol. 2015; 19(6): 701–715.
20.
Danial N N, Hartman A L, Stafstrom C E, Thio L L. How does the ketogenic diet work? Four potential mechanisms. J Child Neurol. 2013; 28(8): 1027–1033.
21.
Gasior M, French A, Joy M T, Tang R S, Hartman A L, Rogawski M A. The anticonvulsant activity of acetone, the major ketone body in the ketogenic diet, is not dependent on its metabolites acetol, 1,2-propanediol, methylglyoxal, or pyruvic acid. Epilepsia 2007; 48(4): 793–800.
22.
Zarnowska I, Luszczki J J, Zarnowski T, Buszewicz G, Madro R, Czuczwar S J, et al. Pharmacodynamic and pharmacokinetic interactions between common antiepileptic drugs and acetone, the chief anticonvulsant ketone body elevated in the ketogenic diet in mice. Epilepsia 2009; 50(5): 1132–1140.
23.
Wlaź P, Socała K, Nieoczym D, Łuszczki J J, Zarnowska I, Zarnowski T, et al. Anticonvulsant profile of caprylic acid, a main constituent of the medium-chain triglyceride (MCT) ketogenic diet, in mice. Neuropharmacology 2012; 62(4): 1882–1889.
24.
Wlaź P, Socała K, Nieoczym D, Żarnowski T, Żarnowska I, Czuczwar S J, et al. Acute anticonvulsant effects of capric acid in seizure tests in mice. Prog Neuropsychopharmacol Biol Psychiatry 2015; 57: 110–116.
25.
Maciejak P, Szyndler J, Turzyńska D, Sobolewska A, Kołosowska K, Krząścik P, et al. Is the interaction between fatty acids and tryptophan responsible for the efficacy of a ketogenic diet in epilepsy? The new hypothesis of action. Neuroscience 2016; 313: 130–48.
26.
Henderson C B, Filloux F M, Alder S C, Lyon J L, Caplin D A. Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis. J Child Neurol. 2006; 21(3): 193–198.
27.
Keene D L. A systematic review of the use of the ketogenic diet in child hood epilepsy. Pediatr Neurol. 2006; 35(1): 1–5.
28.
Neal E G, Chaffe H, Schwartz R H, Lawson M S, Edwards N, Fitzsimmons G, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomized controlled trial. Lancet Neurol. 2008; 7: 500–506.
29.
Lambrechts D A J E, de Kinderen R J A, Vles J S H, de Louw A J A, Aldenkamp A P, Majoie H J M. A randomized controlled trial of the ketogenic diet in refractory childhood epilepsy Acta Neurol Scand. 2016 DOI: 10.1111/ane.12592.
30.
Hsieh D T, Pfeifer H H, Thiele E A. Dietary management of epilepsy. Am Fam Physician. 2012; 86: 1000–1001.
31.
Klein P, Janousek J, Barber A, Weissberger R. Ketogenic diet treatment in adults with refractory epilepsy. Epilepsy Behav. 2010; 19: 575–579.
32.
Freeman J M, Kossoff E H, Hartman A L. The ketogenic diet: one decade later. Pediatrics 2007; 119: 535–543.
33.
Hartman A L, Vining E P G. Clinical aspects of the ketogenic diet. Epilepsia 2007; 48: 31–42.
34.
Kossoff E H, Hartman A L. Ketogenic diets: New advances for metabolism-based therapies. Curr Opin Neurol. 2012; 25: 173–178.
35.
De Lima P A, Prudencio M B, Murakami D K, de Brito Sampaio L P, Neto A M F, Damasceno N R T. Effect of classic ketogenic diet treatment on lipoprotein subfractions in children and adolescents with refractory epilepsy. Nutrition 2017; 33: 271–277.
36.
Kapetanakis M, Liuba P, Odermarsky M, Lundgren J, Hallbook T. Effects of ketogenic diet on vascular function. Europ J Paediatr Neurol. 2014; 18: 489–494.
37.
Vyas M V, Davidson B A, Escalaya L, Costella J, Saposnik G, Burneo J G. Antiepileptic drug use for treatment of epilepsy and dyslipidemia: Systematic review. Epilepsy Res. 2015; 113: 44–67.
38.
Lima PA, de Brito Sampaio L P, Damasceno N R. Ketogenic diet in epileptic children: impact on lipoproteins and oxidative stress. Nutr Neurosci. 2015; 18: 337–344.
39.
Wang H S, Lin K L. Ketogenic diet: An early option for epilepsy treatment, instead of a last choice only. Biomed J. 2013; 36: 16–17.
40.
Martin K, Jackson CF, Levy RG, Cooper PN. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev. 2016 Feb 9; 2: CD001903.
41.
Lee P R, Kossoff E H. Dietary treatments for epilepsy: Management guidelines for the general practitioner. Epilepsy Behav. 2011; 21: 115–121.
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