Does food selection matter in epilepsy treatment?

Epilepsy is a neurological disorder that affects roughly 0.5-1% of the global population. In Poland, nearly 400,000 people are affected by the disease. Studies indicate that it is more prevalent in men than in women. It is characterized by seizures associated with sudden impairments of brain function (A. Verrotti et al. 2020). The causes of epilepsy can be attributed to damage that occurred during fetal life, metabolic disorders, both genetic and developmental, however, in many cases, the cause of the disease remains unknown. Epilepsy is often solely associated with seizures, loss of consciousness, and stiffness of the body, however, symptoms can vary depending on the type of epilepsy.

Epilepsy is usually a curable condition, but it is rare, as most neurological disorders remain incurable. Research shows that nearly 80% of treated patients experience long periods of remission. The treatment involves taking appropriate anti-epileptic medications. Their effects are diverse, hence consulting a specialist is essential. Unfortunately, despite significant medical progress, approximately 30% of epileptic patients show no response to pharmacotherapy (drug-resistant epilepsy). In such cases, comprehensive diagnostics, including the possibility of surgery (K. Rejdak et al. 2016), should be considered. However, surgical intervention should be the last resort. Alternative therapy methods, such as vagus nerve stimulation, and a suitable diet should be attempted first. The ketogenic diet is recommended in the treatment of drug-resistant epilepsy, and scientific evidence supports its effectiveness, especially in young patients (A. Verrotti et al. 2020).

The high-fat diet is a way of eating that assumes an increased supply of fats at the expense of other nutrients. It is a dietary model that requires a daily fat intake of about 90% of energy needs, protein 6%, and carbohydrates only 4%. However, these values should be modified depending on the individual characteristics of the patient. The use of high-fat diets should be under the supervision of a physician and a dietitian, as it is a restrictive dietary model and uncontrolled use may not bring the expected benefits and even pose a threat to the patient's health. The high-fat diet has been used in the treatment of epilepsy since 1921. Dr. Wilder from the Mayo Clinic noticed that a diet based mainly on fats has the same effect on the body as a long-term fast. However, a long-term fast was not practical in the treatment of epilepsy, so other solutions were sought. In addition to the classic high-fat diet, there are also other diets that induce a state of ketosis, such as the modified Atkins diet, the medium-chain triglyceride diet (MCT), and the low glycemic index therapy (LGIT). These diets are less restrictive than the classic high-fat diet and do not require such a high fat intake, about 60-70% of energy needs. When using the classic high-fat diet, fats become the main source of energy, leading to the formation of ketone bodies, which are the main source of energy for the brain.

The mechanism of action of the ketogenic diet is still not completely understood. However, it is believed that ketone bodies and polyunsaturated fatty acids play a special role in the context of its effectiveness in the treatment of epilepsy. Long-term dietary therapy with high-fat diets directly affects the improvement of brain cell function. As a result, it can lead to an increase in the seizure threshold, which is also the primary goal of pharmacotherapy. Over the past few years, many studies have been conducted investigating the effectiveness of the ketogenic diet in the treatment of refractory epilepsy. The results of these studies have been very promising. In 2017, the influence of the classical ketogenic diet on the treatment of refractory epilepsy was investigated in 48 children. The study lasted 16 months. After this time period, the authors observed that a significant percentage of participants experienced a reduction in symptoms compared to the baseline condition. In a 2020 meta-analysis, the evidence for the effectiveness of the classical ketogenic diet and the modified Atkins diet in the treatment of epilepsy in children was reviewed. A total of 5 clinical studies were considered, whose results were heterogeneous. Nevertheless, the authors confirmed the effectiveness of the ketogenic diet in the treatment of epilepsy in children who do not respond to pharmacotherapy and do not qualify for surgery. Most scientific studies pertain to the effectiveness of the ketogenic diet in the treatment of epilepsy in children. The number of studies conducted on adults is significantly lower. However, based on the available results of studies and meta-analyses, it can be concluded that such a nutritional model can also be effective in adults. This is confirmed by a meta-analysis from 2018. The authors emphasized that the ketogenic diet is a promising approach to the treatment of epilepsy in adults and the occurrence of side effects is acceptable.

The consideration of using ketogenic diets in individuals with drug-resistant epilepsy and those who do not qualify for treatment should be contemplated in all age groups. Research conducted over many years affirms the effectiveness of the classical ketogenic diet and its variants. However, it should be emphasized that the entire dietary therapy process should be carried out under the supervision of experts to minimize the risk of adverse effects.