For many years, the
ketogenic diet, including recent variants such the medium-chain
triglyceride (MCT) diet, has been used with good clinical results in the management of
refractory epilepsies, particularly in children. The
antiepileptic effects of the diet, like the
antiepileptic effects of
starvation, have been attributed to accumulation of
ketones, and there are experimental data in animal models to support this hypothesis. Recently, new data about the neuroendocrine response to the
acute phase reaction (stress) have emerged, indicating involvement of various
neuropeptides, including
neuropeptide Y (NPY), which is considered as an endogenous
anticonvulsant. The release of NPY is also stimulated by nutrients in the gut, particularly
fats. Long-chain and, to a greater extent, medium-chain
triglycerides, which are components of the
ketogenic diet, stimulate NPY secretion. This effect may explain the improvement in seizure control after
starvation, use of the classical
ketogenic diet, and use of the MCT diet.