Therapeutic Ketogenic Diet for Refractory Pediatric Epilepsy in Resource Limited Communities

Abstract

Epilepsy is a prevalent neurological disorder in children, with approximately 0.5% of the pediatric population affected worldwide. Despite the widespread use of antiepileptic drugs (AEDs), around 30% of children with epilepsy experience inadequate seizure control, prompting the exploration of alternative treatment options. The ketogenic diet (KD), a high-fat, low-carbohydrate dietary regimen, has emerged as an effective non-pharmacological treatment, particularly for drug-resistant epilepsy (DRE) in children. This review examines the clinical application, efficacy, molecular mechanisms, and potential challenges of the KD in pediatric epilepsy management. The selection criteria encompassed peer-reviewed articles, systematic reviews, randomised controlled trials, and clinical guidelines that addressed the efficacy, molecular mechanisms, safety, and adherence challenges associated with the KD. Data were extracted on seizure reduction rates, metabolic effects, potential side effects, and patient adherence. Various KD variants, including the classical KD, Modified Atkins Diet (MAD), Medium-Chain Triglyceride (MCT) diet, and Low Glycemic Index Treatment (LGIT), offer tailored approaches for different patient needs. The KD’s anticonvulsant effects are attributed to multiple mechanisms, including modulation of neuronal excitability, neurotransmitter balance, mitochondrial function, and neuroinflammation reduction. Despite its therapeutic potential, the KD requires careful monitoring due to potential adverse effects, such as gastrointestinal disturbances, metabolic acidosis, and nutrient deficiencies. The diet’s restrictive nature can also pose adherence challenges, with social and emotional implications for patients and families. The ongoing development of personalised treatment strategies, including genomic and metabolomic profiling, offers promising directions for optimising KD therapy in epilepsy management.