The Effects Of Physical Activity And The Ketogenic Diet On Epilepsy Management: A Systematic Review

Abstract

 Epilepsy remains one of the most common neurological disorders, and approximately one third of patients do not achieve seizure control despite appropriately selected antiseizure medications. In this population, non-pharmacological adjunctive interventions - most notably the ketogenic diet and physical activity - have emerged as important therapeutic considerations. Both strategies are the focus of intensive scientific investigation, and a growing body of evidence highlights their potential efficacy in the management of drug-resistant epilepsy [1–25].

Methods:
 A literature review was conducted including systematic reviews, meta-analyses, narrative reviews, as well as observational and interventional studies on the effects of the ketogenic diet and physical activity in the context of epilepsy treatment. Data on efficacy, safety, mechanisms of action and factors influencing the implementation of both interventions were included. A narrative synthesis of findings was performed with thematic structure.

Results:
 Available meta-analyses confirm that the ketogenic diet reduces seizure frequency in a significant proportion of patients with drug-resistant epilepsy, and in some of them leads to complete remission [1–15]. Its effects include improvement of brain energy metabolism, stabilization of neuronal excitability, modulation of the gut microbiome and neuroprotective effects. At the same time, it has been shown that physical activity is safe for people with epilepsy, improves quality of life, sleep and cognitive functions, and in many studies also reduces seizure frequency [16–25]. Consideration of the mechanisms of action of both interventions and analysis of patient profiles that respond best to therapy allow the formulation of the hypothesis that a lifestyle characterized by higher physical activity may potentially support and optimize the therapeutic effects of the ketogenic diet [13,16–18].

Conclusions:
 The ketogenic diet and physical activity constitute effective and complementary methods supporting epilepsy treatment, especially in drug-resistant cases. They may act synergistically through parallel effects on neuronal energy metabolism, neuroplasticity, the microbiome, and regulation of sleep and stress. Further, direct interventional studies evaluating combinations of metabolic and behavioural strategies in epilepsy therapy are needed.