3rd International Aegean Health Areas Symposium 2023, Uşak, Turkey, 07 March 2023, pp.147-153
This review aims to evaluate the efficacy of the ketogenic diet therapy in adults with drugresistant seizures and to give information about application of the diet therapy. The current evidence regarding super refractory status epilepticus (SRSE) therapy is still insufficient, and the therapy is generally directed in accordance with the experience of the physician in charge. The role of the ketogenic diet in SRSE therapy is well known among pediatric patients, while its efficacy in adult patients has been demonstrated in smaller studies. The optimal time to start the ketogenic diet therapy and the optimal therapy duration are still ambiguous. The ketogenic diet therapy is contraindicated in the presence of fatty acid transport disorders, porphyria, or pregnancy. Patients should be closely monitored during the therapy because of its proteinrestricted nature. Again, because of the diet’s high lipid content, patients should be monitored for hyperlipidemia and gastrointestinal intolerance. The carbohydrate content of the patients’ diet and medications should be minimized in order to achieve ketosis. In addition, patients should be monitored in terms of hypoglycemia. Carnitine supplementation should be made per need, especially in patients in whom ketogenic diet therapy and valproate therapy are given concurrently. Ketogenic diet therapy can be administered via an enteral or parenteral route. The possible interactions between the patient's medications and the ketogenic diet therapy should not be ignored. It is suggested that the blood level of beta-hydroxybutyrate should be monitored in preference to urinary ketone levels because of the high variability in urinary ketones. Patients’ seizure status should be closely monitored during the discontinuation of the diet therapy by increasing the carbohydrate content of the diet gradually. The ketogenic diet therapy should be administered by a multidisciplinary team, in which neurologists, dietitians, and pharmacists take part. Further studies should focus on the optimal timing and duration of the diet therapy and the prescribing of optimal nutrition.