Ketogenic diet and epilepsy: an up-date review

Background and Aims: Ketogenic diet is currently a therapeutic option for the treatment of epilepsy other than anticonvulsant drugs, for which there is a growing interest in Europe and worldwide, mainly due to the persisting number of refractory patients and the adverse side effects of antiepileptic old and new drugs. Aim of the present article is to review literature data regarding the use of the diet in the different types of epilepsies and epilepsy syndromes, trying to better understand the main evidence-based indications for its use.Material and Methods: A literature search was based on a Medline search of published retrospective, not-controlled prospective and randomized controlled trials on the use of the ketogenic diet for the treatment of epilepsies and antiepileptic encephalopathies. In some instances, case reports were also included. A search on standard textbooks and review articles on the use of the ketogenic diet was considered as well. A summary and a critical appraisal of what emerged from the literature for each epileptic syndrome will be discussed in this review.Conclusions: Ketogenic diet is considered as the primary treatment of GLUT-1 deficiency syndrome and pyruvate-dehydrogenase deficiency. It is so far included as secondary option for the so called “catastrophic epileptic encephalopaties of childhood”, and should be a potential treatment against a wide variety of other seizure types and epilepsy syndromes as well as many symptomatic localization-related epilepsies. The best evidence of its efficacy regards refractory infantile spasms, Dravet syndrome and myoclonic-astatic epilepsy as well as epileptic encephalopathies due to cortical migration disorders. There is also a growing interest for dietary treatments for epilepsy other than ketogenic diet, such as the modified Atkins diet and the low glicemic index diet , both providing a daily amount of fat less than the ketogenic diet. Presently, some authors prefer to use the ketogenic diet in infants and younger children, leaving the other two diets for the treatment of older children, adolescents and young adults