Guerreiro Daniela, Almeida Anabela, Ramalho Renata
Nutrition Lab, Egas Moniz Center for Interdisciplinary Research (CiiEM, U4585 FCT), Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal.
Nutritional Immunology-Clinical and Experimental Lab (NICE Lab), Clinical Research Unit, Egas Moniz Center for Interdisciplinary Research (CiiEM, U4585 FCT), Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal.
Nutrients. 2024 Nov 22;16(23):3994. doi: 10.3390/nu16233994.
Refractory epilepsy, characterized by seizures that do not respond to standard antiseizure medications, remains a significant clinical challenge. The central role of the immune system on the occurrence of epileptic disorders has been long studied, but recent perspectives on immunometabolism and neuroinflammation are reshaping scientific knowledge. The ketogenic diet and its variants have been considered an important medical nutrition therapy for refractory epilepsy and may have a potential modulation effect on the immune system, specifically, on the metabolism of immune cells. In this comprehensive review, we gathered current evidence-based practice, ketogenic diet variants and interventional ongoing clinical trials addressing the role of the ketogenic diet in epilepsy. We also discussed in detail the ketogenic diet metabolism and its anticonvulsant mechanisms, and the potential role of this diet on neuroinflammation and neuroimmunometabolism, highlighting Th17/Treg homeostasis as one of the most interesting aspects of ketogenic diet immune modulation in refractory epilepsy, deserving consideration in future clinical trials.
难治性癫痫以对标准抗癫痫药物无反应的癫痫发作为特征，仍然是一个重大的临床挑战。免疫系统在癫痫疾病发生中的核心作用已被长期研究，但最近关于免疫代谢和神经炎症的观点正在重塑科学认知。生酮饮食及其变体被认为是难治性癫痫的一种重要医学营养疗法，可能对免疫系统，特别是对免疫细胞的代谢具有潜在的调节作用。在这篇全面综述中，我们收集了基于当前证据的实践、生酮饮食变体以及正在进行的关于生酮饮食在癫痫中作用的干预性临床试验。我们还详细讨论了生酮饮食代谢及其抗惊厥机制，以及这种饮食对神经炎症和神经免疫代谢的潜在作用，强调Th17/Treg平衡是生酮饮食在难治性癫痫中免疫调节最有趣的方面之一，值得在未来的临床试验中考虑。
