The efficacy of the Ketogenic Diet as a strategy in refractory epilepsy

Abstract

Epilepsy is a chronic neurological disorder characterized by excessive and synchronous electrical discharges affecting the central nervous system, impacting approximately 50 million people worldwide and between 2 and 3 million in Brazil. Refractory epilepsy is diagnosed when seizures persist after the trial of at least two antiepileptic drugs—a condition affecting about 30% of patients that leads to severe neurocognitive, motor, and socioemotional impairments. Given the limitations of conventional pharmacological treatment, this study aims to analyze the efficacy of the ketogenic diet as a therapeutic strategy for refractory epilepsy. To this end, a qualitative narrative review was conducted, focusing on the description and critical interpretation of scientific literature on the topic. The search for literature was carried out in databases such as PubMed, SciELO, and Google Scholar, selecting studies published between 2022 and 2026. The findings indicate that the ketogenic diet—characterized by a high-fat, low-carbohydrate, and adequate-protein composition—induces ketosis, forcing the brain to utilize ketone bodies as na alternative fuel source to glucose. This metabolic shift stimulates the production of the inhibitory neurotransmitter GABA, decreases glutamatergic excitation, promotes mitochondrial biogenesis, and reduces neuroinflammation. Consequently, a reduction of over 50% in seizure frequency is observed in most patients, alongside improvements in sleep patterns, neurocognitive gains, and reduced caregiver burden. However, the effectiveness and safety of this protocol require continuous monitoring by a multidisciplinary team, support from educational materials, and strong family engagement to maintain dietary adherence. Therefore, the targeted application of ketogenic therapy enables seizure control, mitigates the impacts of drug resistance, and establishes itself as a transformative and essential non-pharmacological approach for neurological rehabilitation and quality of life.