Over twenty-five years of ketogenic diet therapy: Supporting children and adults with drug-resistant epilepsy using nutritionally complete ketogenic formulations: A scoping review.

PURPOSE: Ketogenic diet therapy (KDT) has been successfully used as an effective management option for drug resistant epilepsy (DRE) since the 1920 s. The ketogenic formulation studied here (KetoCal) is nutritionally complete, very high in fat, and low in carbohydrates and has played a crucial role in supporting the implementation of KDT for over twenty-five years. This scoping review aims to synthesise the existing literature regarding the safety, acceptability, and efficacy of the ketogenic formulation in supporting the management of DRE.

METHODS

PubMed, Google Scholar and Cochrane databases were searched from January 1998 to November 2024. English and Dutch language studies involving paediatric or adult participants with epilepsy who used the ketogenic formulation were included if the outcomes for the ketogenic formulation group were reported separately and could be extracted. Data extracted included: demographics, type of KD, ratio and volume of ketogenic formulation used, reported outcomes and time points at which measured.

RESULTS

Searches identified a total of 645 articles, 41 met the inclusion criteria. Several reports suggest additional benefits of KDT plus the studied ketogenic formulation versus KDT alone on seizure frequency reduction and seizure severity. Compliance and retention rates varied across studies but appeared higher in those treated with KDT plus the ketogenic formulation. The ketogenic formulation was well tolerated with no major adverse effects reported. Palatability and convenience/ease of use was generally rated highly by patients and parents/caregivers.

CONCLUSIONS

This review highlights the integral role of the studied ketogenic formulation in enhancing compliance, convenience, palatability, and efficacy of KDT for children and adults with DRE. In addition, an unexpected but important finding was the growing evidence for this particular ketogenic formulation's use in intensive care settings, particularly for the management of (super-)refractory status epilepticus.