Ketogenic Diet as a Brain-targeted Therapy in Psychogenic Nonepileptic Seizures: A Neuroimaging Findings-based Nutritional Hypothesis

Abstract

Psychogenic nonepileptic seizures (PNES) are non-epileptic events characterized by altered consciousness and motor activity that mimic epileptic seizures but lack abnormal brain discharges. Despite their prevalence, PNES remain diagnostically challenging, often coexisting with psychiatric and medical conditions. While ketogenic diets (KDs) have shown potential in treating neurological and psychiatric disorders, their impacts on PNES are underexplored. KDs, by shifting metabolism toward lipid oxidation and producing ketone bodies, offer neuroprotective and anti-inflammatory benefits, which may modulate brain connectivity and neurotransmitter balance. Neuroimaging studies, including electroencephalography, functional magnetic resonance imaging, and diffusion tensor imaging, have demonstrated altered brain activity and connectivity in PNES, particularly in regions responsible for emotional regulation, executive function, and motor control. The KD’s ability to restore these disrupted patterns through its anticonvulsant, anti-inflammatory, and neuroprotective properties makes it a potential treatment option for PNES. Preliminary studies, including a pilot trial, have shown promising results in reducing PNES frequency with KD use. However, further research with larger sample sizes and more rigorous methodologies is necessary to confirm these findings. This article proposes KD as a viable treatment for PNES, emphasizing the need for personalized, multidisciplinary approaches and the importance of using neuroimaging techniques and monitoring for potential metabolic complications to ensure long-term safety and efficacy.