Hayden White, Karthik Venkatesh and Bala Venkatesh
Background: Ketosis is currently being utilized as treatment option in paediatric patients with resistant epilepsy. However, the evidence for efficacy in adult epilepsy and other neurological conditions is lacking. The purpose of this systematic review is to examine the evidence for inducing ketogenesis in adult humans with neurological and neurosurgical disorders, both acute and chronic.
Method: We conducted a literature review through electronic databases, including Medline, the Cochrane Library and PubMed. Our search was focussed using the following MeSH terms: ketones, ketonaemia, Bhydroxybutyrate, ketogenic diet, adults, brain trauma, traumatic brain injury, status epilepticus, carbohydratefree diet, neurodegenerative disease, Parkinson’s disease, dementia, Alzheimer’s disease, mild cognitive impairment, intracranial bleed and subarachnoid haemorrhage.
Results: From the literature search, we identified 14 publications that met the selection criteria for inclusion into this study. Of the 14 publications, 3 were randomised controlled trials, 10 were case series (6 prospective and 4 retrospective) and one was a non-randomised placebo control trial. Study subjects included Alzheimer’s disease, severe refractory status epilepticus, intracranial neoplasms, traumatic brain injury and idiopathic Parkinson’s disease. Although studies suggested ketosis may be beneficial, interpretation is limited by poor quality of evidence.
Conclusion: This is the first systematic review of the role of ketones in the management of neurological and neurosurgical disorders. Ketone administration may prove beneficial in the management of a number of these conditions. Better quality studies are required before firm conclusions can be drawn.
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