Introduction
The recent past has seen renewed energy in the field of research examining the efficacy of ketogenic diet in the treatment of drug-resistant (refractory) epilepsy in children. On that note, the researchers have made considerable progress ensuring that there is a large pool of studies to this effect. The increased momentum of research comes in the backdrop of the observation that despite the incessant development of new drugs and forms of treatment thought to be effective, epilepsy remains drug-resistant in approximately 30% of the patients according to Sander (2013). In light of the increasing refractory challenge of seizures, the patients face an uncertain future featuring uncontrolled seizures with unimaginable negative impacts on the quality of life of the patients through interference with their ability to lead a normal life of work and social interactions (Sander, 2013). The situation has created an urgent need for alternative medication whose efficacy supersedes the existing group of medicines. The emergence and subsequent adoption of ketogenic diet (KD) overlies the observation that fasting could be effective in the control of seizures. The modality became common and dominant in the control of epilepsy. However, its application dwindled in the face of drug-related medications, making it to be a preferred method mostly for children suffering from refractory seizures (Prasad, Stafstrom & Holmes, 1996; Freeman, Vining, Pillas, Pyzik, Casey & Kelly, 1998). There is a wide variety of ketogenic diet protocols most of which are based on lipids as opposed to carbohydrates as the primary energy source in the body. Age and gender are the chief determinants of the amount of daily caloric intake in the normal ketogenic diet. Usually, the supply is tweaked in a manner that it supplies relatively high amount of fat and extremely low carbohydrate amounts matching the ratio of 3:1, capped with the usual protein content. The assumption, in this case, is that the ketone bodies that result from the diet have a central role in the control of seizures.
Even with the presumptions of success with the use of ketogenic diet, the claims of high efficacy are products of observational studies. In general, some studies have concluded that there are no watertight corroborations from randomized controlled trials to add to the hypothetical high efficacy of ketogenic diet in the control of refractory seizures especially in adults. Even then, drawing from most of the studies, the researchers came to a conclusion that “in those who have a difficult to control epilepsy on multiple modern antiepileptic drugs, we consider a ketogenic diet a valid option” (Levy & Cooper, 2003). These studies show that treating children with ketogenic diet can be highly effectively in controlling seizure. The reduction in the rate and frequency of the seizures goes as high as 50% in half of the children (Prasad, Stafstrom & Holmes, 1996). In one of the largest existing prospective studies, 3% of the 150 children exposed to ketogenic diet were cured of seizures after three months, 31% enjoyed a 90% reduction in the frequency of their seizures while 26% had a frequency reduction ranging from 50-90% (Freeman et al., 1998). While there is a relatively large pool of studies analysing the impact of ketogenic diet on refractory seizures in children, adults’ studies, on the other hand, are limited, and most of them are inconclusive. The efficacy of the medication in this group remains unknown despite the wide prevalence of the disease in adults. The first, and probably the last definitive study on this age group happened decades ago where Barboka (1929) noted that after one year of KD treatment, 12% of the 100 adults were free from seizures with 44% showing tremendous improvements. In the contemporary world, there is a concerning dearth of similar information despite years of technological advancement in the medical sector. On such grounds, the following study will systematically review some of the studies in this sector with a view to obtaining insightful information regarding the history, efficiency, and cost-effectiveness of the diet in comparison to other forms of treatment that have been previously used to control or cure refractory seizures.
Literature Review
History of ketogenic diet
The famous ketogenic diet, despite being a mainstream medication, is free from pharmaceutical drugs. Its emergence and development lies on the quest to reproduce the success, while eliminating the limitations inherent in non-mainstream application of fasting in the treatment of seizures. While the discovery of the ketogenic diet was a major medical milestone in the 1920s, the development of new anticonvulsant drugs saw its abandonment (Freeman, Kossoff, & Hartman, 2007). While most people with epilepsy have been found to successfully control their convulsions with medication, about 20-30% still have threatening seizures after trying different available medications. For the latter group, particularly the children, ketogenic diet has been brought back to use given that its use has been show to ben highly effective in the management of epilepsy. The history of ketogenic diet use dates back to the years when fasting was the most dominant therapeutic method for the management of epilepsy. In the ancient Greece, physicians treated, among other diseases, epilepsy through a crafted change in the diet of their patients. Baranano and Hartman (2008) argues that despite the common postulation that epilepsy was a supernatural condition, dietary therapy had some rational and physical bases. Still in the collection, the author presents the situational case of a man whose epilepsy disappears after he was exposed to abstinence from drinks and food. The author also notes that attenuating diet may be effective in curing certain mild cases of seizures.