Areas of expertise / Refractory epilepsy

Refractory epilepsy

What are we talking about?

Refractory epilepsy refers to epilepsy that does not respond adequately to drug treatment, resulting in uncontrollable seizures and side effects that affect the patient’s normal development. When epileptic seizures are frequent, affected individuals experience a significant burden on their quality of life and face an increased risk of medical and psychosocial complications.

Prevalence and consequences

Epilepsy, with about 50 million people affected worldwide, is one of the most prevalent neurological conditions globally. It is estimated that approximately 30% of adults and between 20% and 25% of children diagnosed with epilepsy experience resistance to drug treatments.

This challenge triggers uncontrolled seizures, negatively impacting their quality of life. In addition to the physical and emotional limitations associated with uncontrolled seizures, refractory epilepsy can increase the risk of serious injuries, cognitive impairment and psychiatric disorders.

Oral nutritional supplement’s role

The ketogenic diet has emerged as a very effective therapeutic strategy for some people with refractory epilepsy. With a high lipid and a low protein and carbohydrate ratio, this diet has been shown to reduce seizure frequency in many patients.

In this approach, oral nutritional supplements play a crucial role in providing a concentrated source of key nutrients, from vitamins and minerals such as carnitine and selenium as levels can become deficient on a ketogenic diet. These supplements facilitate adherence to the diet, which is essential to maximize its effectiveness in controlling seizures and improving the quality of life of patients with refractory epilepsy.

Frequent questions

1. Does everyone follow the same ketogenic diet?

No, not everyone follows the same ketogenic diet. The ketogenic diet should be adapted and personalized according to individual needs, specific medical conditions and treatment goals. For example, the proportions of macronutrients (fats, proteins and carbohydrates) in the diet may vary depending on each person’s energy needs and ability to metabolize nutrients. Additionally, the types of foods allowed within the ketogenic diet can be adjusted to suit each individual’s specific food preferences and dietary restrictions.

2. What are the main challenges associated with the treatment of refractory epilepsy?

This can significantly decrease the patient’s quality of life and increase the risk of injury and medical complications. Additionally, refractory epilepsy may require a multidisciplinary therapeutic approach and often involves the need to explore advanced treatment options, such as brain surgery or the ketogenic diet, which can be complicated for the patient and her family to manage.

3. Can the ketogenic diet ever be stopped?

If the seizures have been well controlled for 2 years, the doctor may suggest stopping the diet.

The diet is usually gradually withdrawn over several months or even longer. Seizures may worsen if the ketogenic diet is stopped all at once.

Other individual factors, such as age, overall health, dietary preferences, and tolerability of the ketogenic diet, may influence the decision-making process regarding discontinuation.

Bibliography

  1. World Health Organization. Epilepsy. 2024.
  2. Whinting S, Levin S, Mirsattari S, Ramachandran Nair R, et al. Provincial Guidelines for the management of medically refractory epilepsy in adults and children who are not candidates for epilepsy surgery. CCSO. 2016.
  3. Epilepsy Foundation. Ketogenic Diet. 2017.

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