Ketogenic diet in epilepsy treatment

Owing to the fact that ketone bodies possess an antiepileptic effect, an increase in their quantity in the blood leads to a reduction in the frequency of, and even the cessation of, epileptic seizures.

The treatment of epilepsy by the method of increasing the quantity of ketone bodies in the body was used as far back as biblical times; back then, however, the effect was achieved through prolonged fasting. For this reason, that approach can be regarded as merely a prototype of the true ketogenic diet, first used in 1924 at the Mayo Clinic by Russel Wilder. The active development of pharmacology and the arrival on the market of a large number of antiepileptic drugs led to the method being temporarily forgotten. However, thanks to the active work of the Charlie Foundation project, the ketogenic diet returned to active practice and is used to this day.

A large number of studies demonstrate the high effectiveness of the ketogenic diet in the treatment of epileptic syndromes traditionally resistant to treatment: West syndrome, Lennox-Gastaut syndrome, Dravet syndrome, and multifocal epilepsy.

For the first 10 days, the patient visits the clinic on an outpatient basis on a daily basis. During this time, they and their relatives are taught the diet, and laboratory monitoring of the diet's tolerability is carried out: blood tests for acid-base status are performed regularly, and blood ketone levels are measured.

Clinical and EEG monitoring of the antiepileptic effects of the treatment is also carried out. Over the course of this period, the optimal ratio level is determined — the one that possesses the maximum therapeutic effect and produces no side effects. After this, the patient and their relatives return home, where they continue to use the diet, measuring their blood ketone level daily with the aid of a portable device. When the clinical effects and treatment tolerability are good, repeat visits to the clinic are made once every 3–6 months. Repeat visits last 2–3 days and include monitoring of blood indicators, an ultrasound of the abdominal cavity, and prolonged video-EEG monitoring, depending on the results of which the diet's main ratio may be changed upward or downward.

When the results of the ketogenic diet are good, a complete discontinuation of antiepileptic drugs is possible.