Fasting is the only therapeutic measure against epilepsy recorded in the Hippocratic collection. This contribution reviews the use and effects of the KD and its variants for the treatment of adults and children with intractable epilepsy.ĭietary treatments for diseases have probably been used for over 2000 years ( Yuen and Sander, 2014). However, it is not yet known with certainty whether the success of the KD is due to a single or several mechanisms ( Bough and Rho, 2007 Lutas and Yellen, 2013 Rho, 2017 Youngson et al., 2017).īecause epilepsy is a metabolic disease ( Clanton et al., 2017), interest in studies of alterations of metabolism by anticonvulsants such as the KD has increased, as has their importance for the treatment of drug-resistant epilepsy. As presently understood, the KD is involved in multiple mechanisms responsible for biochemical alterations, including cellular substrates and mediators responsible for neuronal hyperexcitability. Several studies have shown that the new variants of the KD have a similar efficacy to the CKD ( Kossoff et al., 2006 Tonekaboni et al., 2010 Coppola et al., 2011 Miranda et al., 2012 El-Rashidy et al., 2013). In the last 20 years, new variants of the KD diet have emerged, including the Modified Atkins diet (MAD), a low-glycemic-index diet, which although it has a high fat content, allows more protein and does not restrict calories and fluids. Regardless of the efficacy of the KD, most patients discontinue the diet because of its unpalatable and restrictive features. Recent studies have found a significantly positive outcome with the use of the KD for treatment of refractory epilepsy in children and adults ( Barborka, 1928 Neal et al., 2008 Kverneland et al., 2015 Liu et al., 2018). 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 ( Rho, 2017). The classic ketogenic diet (CKD) consists of a high-fat and low-protein and carbohydrate diet, with restricted calories and fluids. Some of these patients are not surgery candidates, so it is necessary to search for alternative treatments for epilepsy such as palliative surgery, neuromodulation, and a ketogenic diet (KD). Approximately 30% of patients with epilepsy have refractory epilepsy, that is, have a failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained relief of seizures ( Picot et al., 2008 Kwan et al., 2009). Epilepsy is a disabling and common neurological disease, which can be controlled successfully in most patients with one or more antiepileptic drugs.
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