Article

The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet that has
been employed as a non-pharmacologic therapy for refractory epilepsy. Several
multicenter and two randomized studies have demonstrated the efficacy of the
ketogenic diet and the modified Atkins diet for children and adolescent with
pharmacoresitant epilepsy. In order to facilitate patient tolerability and
palatability, the diet protocols are gradually modified including changes in
ratios of the fat versus non-fat components and the initiation of the diet with
or without fasting. The modified Atkins diet is now used as an alternative diet.
A randomized trial establishing the efficacy of the modified Atkins diet is now
available. More recently, the low glycemic index diet seems to be used
successfully for pharmacoresistant epilepsy but there are currently only open
studies. Looking at the clinical efficacy of dietary treatments, the studies
usually report a greater than 50% reduction in seizure frequency in about half of
patients at 3 months under diet. Most of the patients who are responders to the
ketogenic diet exhibited a decrease in seizure frequency within two months of
treatment onset. Efficacy of the ketogenic diet has also been reported for
teenager and adult patients. Dietary treatment of epilepsy should not be
considered as a last chance treatment. It can be used during the investigation
for epilepsy surgery even in case of structural abnormalities. In some epilepsy
syndromes such as infantile spasms, myoclonic-astatic epilepsy and refractory
status epilepticus, an early use seems helpful. The exact underlying mechanisms
are unknown and remain a topic of active research.
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Langue : ANGLAIS