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The Efficacy and Safety of Ketogenic Diets in Drug-Resistant Epilepsy in Children and Adolescents: a Systematic Review of Randomized Controlled Trials

  • Diabetes and Obesity (M Dalamaga and F Magkos, Section Editors)
  • Published:
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Abstract

Purpose of Review

Drug-resistant epilepsy represents around one-quarter of epilepsies worldwide. Although ketogenic diets (KD) have been used for refractory epilepsy since 1921, the past 15 years have witnessed an explosion of KD use in the management of epilepsy. We aimed to review evidence from randomized controlled trials (RCTs) regarding the efficacy and safety of KD in drug-resistant epilepsy in children and adolescents.

Recent Findings

A literature search was performed in the Pubmed, Cohrane, Scopus, ClinicalTrials.gov, and Google Scholar databases. Predefined criteria were implemented regarding data extraction and study quality. Data were extracted from 14 RCTs in 1114 children and adolescents aged from 6 months to 18 years. Primary outcome was seizure reduction after the intervention. In 6 out of the 14 studies, there was a statistical significant seizure reduction by > 50% in the KD-treated group compared with the control group over a follow-up of 3–4 months. Secondary outcomes were adverse events, seizure severity, quality of life, and behavior. Gastrointestinal symptoms were the most frequent adverse events. Serious adverse events were rare.

Summary

We conclude that the KD is an effective treatment for drug-resistant epilepsy in children and adolescents. Accordingly, RCTs investigating long-term impact, cognitive and behavioral effects, and cost-effectiveness are much anticipated.

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Abbreviations

AEDs:

Anti-Epileptic Drugs

ASDs:

Anti-Seizure Drugs

BDNF:

Βrain-Derived Neurotrophic Factor

BHB:

Beta-Hydroxybutyric Acid

BMI:

Body Mass Index

CAU:

Care As Usual

CKD:

Classic Ketogenic Diet

GABA:

Gamma Aminobutyric Acid

GI:

Gastrointestinal

KD:

Ketogenic Diet

LGIT:

Low Glycemic Index Treatment

MAD:

Modified Atkins Diet

MCT:

Medium Chain Triglycerides

NADH:

Nicotinamide Adenine Dinucleotide Phosphate

RCTs:

Randomized Controlled Trials

ROS:

Reactive Oxygen Species

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Authors and Affiliations

  1. 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece

    Evangelia Desli & Athanasios Evangeliou

  2. 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece

    Martha Spilioti

  3. 1st Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece

    Foteinos Styllas

  4. Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg, Denmark

    Faidon Magkos

  5. Department of Biological Chemistry, Medical School, National and Kapodistrian, University of Athens, Athens, Greece

    Maria Dalamaga

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Correspondence to Evangelia Desli.

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Desli, E., Spilioti, M., Evangeliou, A. et al. The Efficacy and Safety of Ketogenic Diets in Drug-Resistant Epilepsy in Children and Adolescents: a Systematic Review of Randomized Controlled Trials. Curr Nutr Rep 11, 102–116 (2022). https://doi.org/10.1007/s13668-022-00405-4

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