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Epilepsia Open. 2018 Feb 19;3(1):9-17. doi: 10.1002/epi4.12098. eCollection 2018 Mar.

Ketogenic diet for treatment of intractable epilepsy in adults: A meta-analysis of observational studies.

Liu H1,2,3, Yang Y4, Wang Y5, Tang H6, Zhang F1,2,3, Zhang Y1,2,3, Zhao Y1,2,3.

Author information

1
School of Public Health and Management Chongqing Medical University Chongqing China.
2
Research Center for Medicine and Social Development Chongqing Medical University Chongqing China.
3
Collaborative Innovation Center of Social Risks Governance in Health Chongqing Medical University Chongqing China.
4
Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing China.
5
Department of Hepatobiliary Surgery The Second Affiliated Hospital of Chongqing Medical University Chongqing China.
6
Department of Critical Care Medicine The First Affiliated Hospital of Chongqing Medical University Chongqing China.

Abstract

The ketogenic diet (KD) is an effective treatment for children with drug-resistant epilepsy and has been widely used in young children. Adult patients with intractable epilepsy would also benefit from this dietary treatment. However, only a few studies have been published, and the use of the KD in intractable epilepsy in adults has been limited. This meta-analysis summarized the findings of the relevant published studies to identify the efficacy of the KD for the treatment of intractable epilepsy in adults. In this meta-analysis, PubMed, Embase, and Cochrane Library were used for searching studies concerning the effects of the KD and its major subtypes with intractable epilepsy in adults published up to January 10, 2017. The primary outcomes were seizure freedom, seizure reduction by 50% or more, and seizure reduction by <50%. The quality of the methodology of the observational studies was reviewed by using the Newcastle-Ottawa Scale. We identified 402 articles, of which, 16 studies including 338 patients met the inclusion criteria. The results of the meta-analysis showed that the combined efficacy rates of all the symptoms of seizure freedom, seizure reduction by 50% or more, and seizure reduction below 50% in adults with intractable epilepsy were 13%, 53%, and 27%, respectively. The adverse reactions of the KD were mild, whereas low glycemic index diet (LGID) and low-dose fish oil diet (LFOD) may have fewer side effects. Weight loss, high level of low-density lipoprotein, and elevated total cholesterol were most frequent. The meta-analysis indicates that the KD for refractory epilepsy in adults is a well-tolerated treatment and that its side effects are acceptable, which show that the KD is a promising treatment in adult intractable epilepsy. Further research is needed to assess which type of diet or ratio is more effective in the KD treatment.

KEYWORDS:

Adult; Dietary treatment; Efficacy; Intractable epilepsy; Ketogenic diet

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