Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
Translational Nutrition Neuroscience Working Group, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
Nutr Rev. 2022 Sep 5;80(10):2064-2075. doi: 10.1093/nutrit/nuac021.
Epilepsy is a chronic neurological disorder that has social, cognitive, and psychological consequences to the patient.
The effects of the ketogenic diet (KD) in children and adults with pharmacoresistant epilepsy on cognitive function were evaluated in this systematic review.
The MEDLINE, Cochrane Library, Scopus, Web of Science, and LILACS databases were searched up to February 2021.
From the 2973 records initially identified, 24 studies were included in the systematic review. These records were screened via PICO criteria, focusing on studies that evaluated the effects of KD on cognitive function of patients with pharmacoresistant epilepsy.
Nineteen studies described improvements in cognitive function attributed to KD; improvements were not observed in 2 studies, but neither was aggravation. Contradictory results were reported in 3 studies, depending on the method used to assess cognition. At first glance, cognitive function appears to be associated with the number of seizures, diet effectiveness, amount of carbohydrate ingested, and antiseizure medication used. However, due to the diversity of methods used to assess cognitive function, especially self-perception of cognitive improvement by the patient, it was not possible to confirm this hypothesis.
It was not possible to confirm if KD itself promotes improvements in cognitive function in patients with pharmacoresistant epilepsy. Certainly, more studies are needed with better methodological quality, larger and more homogeneous samples in relation to epileptic syndrome and clinical aspects of the disease, more rigid monitoring of adherence to the diet, and use of standardized tests for neuropsychological assessment. Systematic Review Registration: PROSPERO registration no. CRD42019129236.
癫痫是一种慢性神经系统疾病，会对患者的社交、认知和心理产生影响。
本系统评价评估了抗药性癫痫患者应用生酮饮食（KD）对认知功能的影响。
对 MEDLINE、Cochrane 图书馆、Scopus、Web of Science 和 LILACS 数据库进行了检索，检索时间截至 2021 年 2 月。
最初确定的 2973 条记录中，有 24 项研究被纳入系统评价。这些记录通过 PICO 标准进行了筛选，重点关注评估 KD 对耐药性癫痫患者认知功能影响的研究。
19 项研究描述了 KD 可改善认知功能；2 项研究未观察到改善，但也未恶化。3 项研究报告了相反的结果，这取决于用于评估认知的方法。乍一看，认知功能似乎与发作次数、饮食有效性、摄入的碳水化合物量和使用的抗癫痫药物有关。然而，由于用于评估认知功能的方法多种多样，尤其是患者对认知改善的自我感知，因此无法证实这一假设。
无法确定 KD 本身是否会促进耐药性癫痫患者认知功能的改善。当然，需要更多具有更好方法学质量的研究，涉及到癫痫综合征和疾病临床方面的更大和更同质的样本，更严格地监测对饮食的依从性，以及使用标准化的神经心理评估测试。系统评价注册：PROSPERO 注册编号 CRD42019129236。
