Page 57 - BH-2-1

Brain & Heart Impact of ketogenic diet in adults with drug-resistant epilepsy

In 1921, Dr. Wilder introduced the KD—a low- 2.2. Study design and data collection
carbohydrate, high-fat diet—for epilepsy treatment. We conducted a single-center, prospective, and open-
5
However, the discovery and development of antiseizure label study with a 3-month follow-up period. Clinical
drugs postponed further exploration of the KD after 1938. information, neuropsychological scales, and 2-h
It was not until 1994 that the KD experienced a resurgence electroencephalography (EEG) were collected before
in clinical epilepsy studies.
initiation and after 3 months of KD treatment. The MAD
The classical KD (CKD) was first used for children with treatment with medium-chain triglyceride added was
refractory epilepsy, involving a one- or two-day fast in the conducted in this study. The effect of MAD on seizure
hospital before initiating CKD to induce rapid ketosis. frequency was assessed by Engel classification. Patients
However, CKD poses challenges due to its high fat and were considered responders if they had ≥50% seizure
severely restricted calorie, protein, and fluid requirements, reduction and non-responders if they had <50% seizure
resulting in low retention and tolerability. To address these reduction from baseline. Written informed consent was
limitations, a less restrictive KD known as the modified obtained from all the participants or their guardians.
Atkins diet (MAD) was developed for use in adults with
refractory epilepsy. In contrast to CKD, MAD treatment The sentence should be revised to During the MAD
is initiated on an outpatient basis without a fasting period treatment, a ketogenic dietitian and a doctor guided
and lacks calorie restrictions. Over the past two decades, the diet treatment together. The estimated energy
KD treatment has been widely applied to children with requirements of patients were calculated according to their
drug-resistant epilepsy, with established efficacy and baseline data. All patients received a document from the
safety. However, the efficacy of MAD in adults with dietitian, including instructions on how to follow the diet
6-8
drug-resistant epilepsy remains elucidated only in several and acceptable recipes. MAD was prescribed to provide a
14
epilepsy centers. In addition, the impact of MAD on minimum of 65% of total calories from fat. Carbohydrates
9,10
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epileptiform discharge remains unclear. were limited to 15 – 30 g/day (approximately 5% of total
calories). Urine ketones were monitored to assess the level
Recent findings indicate that the KD not only reduces of ketosis and compliance. Patients were followed up
15
seizure frequency but also improves behavioral and through telephone calls at 2 weeks, 4 weeks, and 2 months
cognitive functions in children with refractory epilepsy, after starting the diet. A clinical appointment was arranged
which include vocabulary, adaptation, and gross motor 3 months after initiation to reevaluate laboratory tests,
skills. 11,12 However, previous studies assessing cognitive neuropsychological scales, and EEG.
improvements in adults with refractory epilepsy relied
solely on subjective evaluations from patients and their Data obtained at baseline included demographic
families. Objective cognitive scales were seldom employed information, detailed seizure characteristics, and previous
13
to investigate the impact of the KD on cognitive function. history. We collected information on the age of seizure
onset, seizure types, duration of seizures, seizure frequency,
Our study aims to explore the efficacy, safety, and
cognitive impact of MAD in adults with drug-resistant and the number of ASMs. Previous history encompassed
epilepsy. Furthermore, we seek to analyze changes in surgical history and a history of febrile convulsions.
epileptiform activity during MAD. Baseline seizure frequency was assessed according to the
average of 3 months before initiation.
2. Methods To evaluate the safety of MAD, we also recorded the

2.1. Patients blood tests. Blood tests mainly focused on lipid metabolism
(total cholesterol, low-density lipoprotein cholesterol, high-
Sixteen patients diagnosed with drug-resistant epilepsy density lipoprotein cholesterol, total triglycerides), glucose
at Xuanwu Hospital between May 2021 and January 2023 metabolism (fasting blood glucose), and liver and kidney
were enrolled in our study. The inclusion criteria were as metabolism biomarkers (aspartate aminotransferase,
follows: (i) Age 16 – 60; (ii) experiencing at least three alanine aminotransferase, creatinine, blood urea nitrogen).
countable seizures per month; (iii) ensuring that the doses
of ASMs remained unchanged; (iv) having a body mass Neuropsychological scale assessments, including the
index >18.5 kg/m . Exclusion criteria were as follows: auditory verbal learning test (AVLT) instant recall, choice
2
(i) Previous use of KD treatment; (ii) undergoing surgery or reaction time, and visual searching task, were performed
neurostimulation in the previous 12 months; (iii) pregnancy to evaluate the memory, alertness, and attention functions
or planning for pregnancy; (iv) severe intellectual of patients. These tests were conducted using a web-based
impairments; (v) possessing other contraindications to the system called the “Online Psychological Experiment
KD; and (vi) unavailable for follow-up. System” (47.95.214.92/lattice/).

Volume 2 Issue 1 (2024) 2 https://doi.org/10.36922/bh.1978