Rosnące zastosowanie diet ketogenicznych w leczeniu epilepsji w Ameryce Łacińskiej: przegląd systematyczny i meta-analiza

BACKGROUND: Ketogenic Dietary therapies, (KDT) are an established treatment option for refractory epilepsy in both pediatric and adult patients. Despite its historical use, there are limited studies examining the current use and efficacy of the KDT for treating refractory epilepsy in Latin America. This systematic review and meta-analysis aim to evaluate the proportion of patients achieving seizure reduction and seizure freedom with KDT in Latin American populations. METHODS: A literature search was conducted in PubMed, Embase, and LILACS databases for studies published until September 2, 2024. INCLUSION CRITERIA: i. Latin American studies ii. Language: English, Spanish, Portuguese iii. INTERVENTION: Classical Ketogenic Diet (cKD), Modified Atkins Diet (MAD), Medium Chain Triglycerides Diet (MCTD), Low Glycemic Index Diet (LGIT) iv. Reported seizure reduction outcomes and adverse effects. EXCLUSION CRITERIA: i. Studies with overlapping populations ii. CASE REPORTS: Risk of bias was assessed using New Castle-Ottawa Scale and statistical analysis was made using StataMP 18 software. RESULTS: A total of 345 articles were initially identified, of which 13 studies met the inclusion criteria for this review, gathering a total of 566 participants distributed in Argentina, Brazil, Chile, Colombia and Mexico. Meta-analysis results indicate that 69% of patients (95% IC: 57-82%) experienced seizure reduction during KDT treatment. Additionally, In terms of seizure freedom, the analysis exhibits a pooled effect of 12% of patients (95% CI: 9-16%) that achieved complete seizure freedom. Adverse effects were analyzed as secondary outcomes, with 270 patients experiencing treatment related side effects. DISCUSSION: The findings from this meta-analysis demonstrate that a substantial proportion of patients in Latin America experienced seizure reduction with an smaller subset achieving seizure freedom during KDT treatment, with pooled estimates consistent with those reported in high-income settings. However, high heterogeneity values can be related to diversity among treatment protocols, type of patients and different epileptic syndromes treated. Therefore, further studies are necessary to explore the long-term effects and challenges of the KDT programs in Latin America.