The beneficial effect of probiotics as a supplementary treatment in drug-resistant epilepsy: a pilot study

The ketogenic diet influences taxonomic and functional composition of the gut microbiota in children with severe epilepsy

The gut microbiota has been linked to various neurological disorders via the gut–brain axis. Diet influences the composition of the gut microbiota. The ketogenic diet (KD) is a high-fat, adequate-protein, low-carbohydrate diet established for treatment of therapy-resistant epilepsy in children. Its efficacy in reducing seizures has been confirmed, but the mechanisms remain elusive. The diet has also shown positive effects in a wide range of other diseases, including Alzheimer’s, depression, autism, cancer, and type 2 diabetes. We collected fecal samples from 12 children with therapy-resistant epilepsy before starting KD and after 3 months on the diet. Parents did not start KD and served as diet controls. Applying shotgun metagenomic DNA sequencing, both taxonomic and functional profiles were established. Here we report that alpha diversity is not changed significantly during the diet, but differences in both taxonomic and functional composition are detected. Relative abundance of bifidobacteria as well as E. rectale and Dialister is significantly diminished during the intervention. An increase in relative abundance of E. coli is observed on KD. Functional analysis revealed changes in 29 SEED subsystems including the reduction of seven pathways involved in carbohydrate metabolism. Decomposition of these shifts indicates that bifidobacteria and Escherichia are important contributors to the observed functional shifts. As relative abundance of health-promoting, fiber-consuming bacteria becomes less abundant during KD, we raise concern about the effects of the diet on the gut microbiota and overall health. Further studies need to investigate whether these changes are necessary for the therapeutic effect of KD.

The ketogenic diet changes both the relative abundance of gut microbiota and their metabolic activities. The diet forces a shift from carbohydrates to ketones as a primary energy source and has demonstrated efficacy in reducing epileptic seizures in children. After animal models implicated gut microbiota in this amelioration, Stefanie Prast-Nielsen, of Sweden’s Karolinska Institutet, and her team sequenced microbiotic DNA of fecal samples from 12 children with epilepsy before and after 3 months on a ketogenic diet. Changes included reductions in the numbers of Bifidobacterium and an increase in Escherichia coli. Carbohydrate metabolism significantly changed after 3 months on the diet. Some reductions raise questions about the diet’s potential impact on gut and overall health. More studies are also needed to discern the mechanistic impact of these changes on seizure activity.