Keto Clarity: A Comprehensive Systematic Review Exploring the Efficacy, Safety, and Mechanisms of Ketogenic Diet in Pediatric Epilepsy

Youmna Faheem; Amisha Jaiswal; Kainaat Shergill; Kusalik Boppana; Naiela E Almansouri; Saloni Bakkannavar; Ann Kashmer Yu

doi:10.7759/cureus.54863

Keto Clarity: A Comprehensive Systematic Review Exploring the Efficacy, Safety, and Mechanisms of Ketogenic Diet in Pediatric Epilepsy

Cureus. 2024 Feb 25;16(2):e54863. doi: 10.7759/cureus.54863. eCollection 2024 Feb.

Authors

Youmna Faheem¹, Amisha Jaiswal², Kainaat Shergill³, Kusalik Boppana⁴, Naiela E Almansouri^{2

5}, Saloni Bakkannavar¹, Ann Kashmer Yu²

Affiliations

¹ Pediatrics, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
² Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
³ General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
⁴ Internal Medicine and Gastroenterology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
⁵ Internal Medicine, University of Tripoli, Tripoli, LBY.

Abstract

Epilepsy, a widespread neurological disorder characterized by recurrent seizures, affects millions globally, with a significant impact on the pediatric population. Antiepileptic drugs (AEDs) constitute the primary treatment; however, drug-resistant epilepsy (DRE), especially in children, poses a therapeutic challenge. Alternative interventions, such as surgery, vagus nerve stimulation, and the ketogenic diet (KD), have been explored. This systematic review aims to investigate various types of KDs, their distinctions, their effectiveness, and their safety concerning the reduction of seizure frequency, achieving seizure freedom, and the occurrence of adverse events. The study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was conducted using databases such as PubMed Central (PMC), MedLine, and Science Direct to identify relevant articles. Eligibility criteria and quality assessment tools were applied to evaluate the potential risk of bias and select 11 articles for inclusion in this review. The selected articles encompassed four randomized controlled trials (RCTs), two systematic reviews, and five narrative reviews. The data collected for this review was completed on October 2, 2023. Challenges, such as palatability, cultural factors, and adherence difficulties, were identified. Family or caregiver involvement plays a pivotal role in treatment success. Despite numerous RCTs and reviews, information gaps persist, hindering conclusive outcomes. Evaluating the risk-benefit ratio is crucial, considering potential side effects. The highly individualized nature of KD therapy, influenced by diverse seizure types and syndromes, necessitates a trial-and-error approach monitored by a multidisciplinary team. Long-term safety and efficacy demand continuous real-life patient data review. In summary, while KD presents a promising alternative for DRE, its success relies on meticulous planning, individualized implementation, and ongoing research to address existing challenges and information gaps.

Keywords: classic ketogenic diet; drug-resistant epilepsy (dre); epilepsy; ketogenic diet; low glycemic index treatment (lgit); medium-chain triglyceride ketogenic diet (mctkd); modified atkins diet (mad); pediatric neurology; pediatrics; seizure.

Publication types

Review