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Ketogenic Diet – Anticonvulsant Mechanism — SCE Neurology MCQ

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ModerateEpilepsy & Seizure DisordersKetogenic Diet – Anticonvulsant MechanismSCE Neurology

A 45-year-old woman with drug-resistant epilepsy is being considered for the ketogenic diet. What is the mechanism by which the ketogenic diet may reduce seizures?

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Correct answer: D — The exact mechanism is not fully understood, but it involves shifting brain metabolism from glucose to ketone bodies (beta-hydroxybutyrate, acetoacetate), which may have direct anticonvulsant effects through modulation of GABA, glutamate, KATP channels, and mitochondrial function

The ketogenic diet (high-fat, low-carbohydrate, adequate protein) forces the brain to use ketone bodies instead of glucose as its primary fuel. Proposed anticonvulsant mechanisms include: (1) increased GABA synthesis, (2) reduced glutamate excitotoxicity, (3) activation of KATP channels, (4) improved mitochondrial function, (5) modulation of neurotransmitter release, (6) epigenetic effects. It is evidence-based for drug-resistant epilepsy (particularly in children) and has growing evidence in adults. NICE NG217 recommends considering the ketogenic diet for drug-resistant epilepsy. A: It reduces glucose utilisation. C: It provides alternative energy. D: Anticonvulsant effects are metabolic, not weight-related. E: It has proven efficacy.

Reference: NICE NG217 (2025); Kossoff et al. Ketogenic Diet Practice Guidelines