Most of us have come across the ketogenic diet (commonly known as the keto diet) at some point in our lives or perhaps tried it to reduce weight or enhance overall health. But have you ever considered its remarkable role in treating one of the most challenging health conditions, epilepsy? This article explores the ketogenic diet, including its variations and its contribution as a treatment option for epilepsy. Discover how this dietary approach can provide hope for many individuals finding a way to manage their epilepsy. 

Epilepsy 

Epilepsy is a well-known chronic neurological disease that causes a tendency to develop recurrent unprovoked seizure activities. A seizure is a sudden electrical discharge in the brain that leads to temporary alteration in its function, appearing most of the time in the form of involuntary movements of a part or whole of the body.  

Not everyone with seizures has epilepsy, as they can happen due to other causes. A person is said to have epileptic seizures when they develop two or more electrical activities that are unprovoked, meaning that they happen without a triggering factor.¹ 

Epilepsy facts

• Epilepsy is a common disease; it nearly affects 50 million individuals all around the globe
• Most people with epilepsy live in low- or middle-income countries² ​
• Epilepsy affects all ages; however, it is higher in the extremes of age (young children and elderly individuals)
• Men (Assigned male at birth)  are slightly more affected than females (assigned female at birth)¹ ​​ 

Classification of epileptic seizures 

Epilepsy is classified into the following types: 

1. Focal or Partial: when the discharge happens in a certain area of the brain
2. Generalised: is the seizure activity that involves all of the brain structures
3. Combined focal and generalized
4. Unknown³​

Symptoms 

A person may have one or more of the following symptoms: 

• Fits or uncontrollable movement of a body part like a leg, arm or multiple parts 
• Confusion or loss of consciousness
• Abnormal sensations like hearing voices or unusual tastes and smells
• Episodes of staring⁴ ​  

Causes of epilepsy 

Epilepsy has a wide number of causes, and they can be classified into broad categories such as: 

• Structural: caused by a defect in one of the structures of the brain or its blood vessels
• Genetic: every day scientists discover new genes that are believed to cause certain types or syndromes of epilepsy
• Infectious: like meningitis and encephalitis
• Immune condition: some autoantibodies are linked to epilepsy
• Birth-related: any birth event that causes reduced oxygen delivery to the brain can lead to epilepsy. 
• Brain injury
• Metabolic: when there is a problem with the mechanisms and chemical reactions that lead to energy generation within the body^4,5 

Treatment options available for epilepsy

1. Antiepileptic medications: For example sodium valproate or carbamazepine. 70% of the cases have full control of their seizures with the use of the right medication
2. Brain surgery: The doctor may choose this option when the medications fail to control the seizures and the problem is found in a small area that can be resected in surgery
3. Vagus nerve stimulation: This is another method to be used for uncontrolled epilepsy. It involves the insertion of a device in the neck. It stimulates the vagus nerve to send impulses that in turn calm down the seizure activity
4. Ketogenic diet

The ketogenic diet 

The ketogenic diet has emerged as a hope for people, especially children, with hard-to-manage epilepsy. Its advantage is that it is a much safer alternative as well as being reversible.  

What is a ketogenic diet? 

The regular diet contains carbohydrates or sugar, proteins, and fats as the sources of energy. However, carbohydrates are normally the primary source of energy, and the diet proportion reflects these needs.  

On the other hand, the ketogenic diet contains high fat, and low carbohydrate and protein proportions. It uses fat as the energy provider and creates a state similar to fasting.  

The liver produces ketone bodies as a byproduct component of fat breakdown, hence the name (keto).⁶ ​ 

The history of the use of the ketogenic diet

• Fasting is considered one of the oldest treatments for epilepsy. It has been recognised since the Hippocratic and biblical eras
• The first scientific report about the benefits of fasting in treating epilepsy was published in the early 20^th century
• Further studies were then conducted to study the role of starvation and its effect on epilepsy patients. As a result, in 1920 the name ketogenic diet appeared to describe a diet low in carbohydrates but rich in fat content
• The ketogenic diet became less popular after the discovery of easier-to-use more efficient antiepileptic medications
• In the nineties, the Ketogenic diet started to regain its popularity after the spread of its success stories
• Now their ketogenic diet is available in over 45 countries and new studies and modifications are being made with each day⁷  

How does it work? 

The exact benefit of the ketogenic diet for epileptic individuals remains unclear. However, it is believed that its effect is due to the action of ketone bodies that act by stabilising the electrical activity of brain cells.   

Types of ketogenic diet

The doctor will choose the appropriate type based on the patient's condition. 

Classic ketogenic diet

In the classic type, fat constitutes about 90% of the diet and both carbohydrates and proteins form the remaining 10%. It is calculated for the patient in the form of fat to carbohydrate ratio with the addition of proteins. It is the most restricted type. 

Medium-chain triglyceride diet (MCT)

Medium-chain fat produces more energy than the long-chain type used in the classic diet; this allows for lower fat content and higher carbohydrate/protein content to make the diet more appetising. 

Modified atkins diet (MAD)

Only 65% of the calories are derived from fat and 45% from carbohydrates and proteins. It is more liberal with fewer restrictions on weighting the food proportions like the previous types. 

Low glycaemic index treatment (LGIT)

It utilises low glycemic index foods, meaning the food that has a low tendency to raise blood sugar after its ingestion.⁷ 

Side effects of a ketogenic diet 

The symptoms appear with the start of the treatment and improve with time, they include: 

• Weight loss
• Changes of the normal bowel habits like diarrhoea or constipation
• Vomiting
• Loss of energy

How effective is the ketogenic diet? 

Most studies show promising results regarding the efficacy of the ketogenic diet in reducing seizure frequency and control of epilepsy. This is seen especially in children and evidence regarding its positive impact in adults also continues to rise. 

However, more research is needed in many areas including the mechanisms of action of the ketone bodies in reducing seizure activity and why certain diet types are suitable for some individuals and not others.⁸

How is the ketogenic diet implemented? 

• The implementation of the diet must be under the supervision of a team of health professionals to ensure the safety of the patient and the proper way of administration. The team consists of a dietitian, a specialist nurse, and a neurologist. All members of the team should have experience with the ketogenic diet. 
• The patient is then assessed for suitability for the treatment. This involves dietary, clinical, neurological and laboratory assessment.  
• The patient is advised to make changes to their food before starting the ketogenic diet to slowly adapt to the new diet and to ensure compliance. 
• The appropriate diet type and plans are set according to the patient's needs. 
• The patient should attend follow-ups to monitor their health and the effectiveness of the treatment, and to adjust the plan if required.⁹

Summary 

Epilepsy is one of the most common neurological diseases worldwide and is capable of severely impacting an individual's quality of life if it is not controlled properly. Most of the time, it is managed with antiepileptic medications. However, if the medications prove ineffective, the high-fat/low-carbohydrate ketogenic diet can provide the safest and easiest treatment option for hard-to-control epilepsy in children and adults. The diet must be undertaken with professional supervision. The increased use of the ketogenic diet for epilepsy reflects the need for further research to understand the mechanisms behind its efficacy and positive impact.