Pharmacologically Resistant Epilepsy.

Pharmacologically Resistant Epilepsy.

The ketogenic diet in pharmacologically resistant epilepsy

Epilepsy is a disorder of the central nervous system characterized by the persistent occurrence of sudden, often multiple, seizures that strike without warning and manifest with involuntary, abrupt, and uncontrolled muscle movements, sometimes accompanied by loss of consciousness, leading to overall deterioration. This disease is also considered a social problem both due to the intrinsic severity of the disease and its repercussions on the families of young patients. The use of the ketogenic diet as a therapy for pharmacoresistant epilepsy dates back to the 1920s.

In fact, W.G. Lennox in his book “Epilepsy and Relative Disorders” reports the case of a wealthy New York lawyer whose son had uncontrollable multiple seizures with the drugs available in 1920. The family turned to Hugh Conklin, a proponent of natural methods who believed he could treat the disease with prayer and fasting. The child’s seizures significantly improved during the weeks of the “water-based diet”, prompting the parents to seek an alternative but equally effective solution; the child’s uncle, a professor of Pediatrics, enlisted the help of Dr. Howland and his colleagues at Johns Hopkins in Baltimore, where research into metabolic modifications of the body during fasting began. This led to the development of the ketogenic diet; the use of this innovative therapy was included in almost all texts on childhood epilepsy, and numerous American centers organized new dietary therapy programs.

From 1921 onwards (Wilder “The Effect of Ketonemia on the Course of Epilepsy”, Mayo Clinic Bull. 2:307, 1921), scientific studies on the use of the ketogenic diet as a therapy for epilepsy multiplied. After this initial enthusiasm, interest in the diet waned rapidly in the 1940s and 1950s; it was only rediscovered from the 1970s onwards and is currently used as a therapy for pharmacoresistant epilepsy in most countries worldwide. In recent years, numerous scientific studies on the use of this diet have been published by researchers from all five continents, and especially in English-speaking countries, support from patient and family associations is very strong and contributes to the dissemination and understanding of the diet.

Guidelines suggest that the ketogenic diet be considered when at least 3-4 attempts at drug treatment have failed.
In this condition, the ketogenic diet offers effective control of epileptic seizures by providing the brain with essential “fuel” in the form of ketone bodies for cerebral metabolic activity.
The debate is still ongoing internationally as to whether there are specific forms of epilepsy that may benefit more from ketogenic therapy: currently, everyone focuses their interest on pharmacoresistant forms.

Epilepsy is one of the most common neurological disorders, with an estimated 65 million epilepsy patients worldwide, of which only in Europe there are 6 million. In 70% of cases, it manifests before the age of 12 with possible negative consequences on psychomotor development and social repercussions.
In Italy, there are 500,000 children with epilepsy, of whom over 40% are drug-resistant, and it is estimated that over 30,000 new cases are diagnosed each year, 60% of which are in childhood. It is often difficult to identify the cause of the condition and therefore determine the best therapy. Epilepsy is the main neurological disease in children.
Unfortunately, in Italy, there is still a lack of widespread culture regarding the nutritional treatment of epilepsy through the ketogenic diet, which contrasts with the international landscape where such an approach is much more common.