Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Jun 20, 2025; 15(2): 104328
Published online Jun 20, 2025. doi: 10.5493/wjem.v15.i2.104328
Unraveling the nutritional challenges in epilepsy: Risks, deficiencies, and management strategies: A systematic review
Mohammed Al-Beltagi, Nermin Kamal Saeed, Adel Salah Bediwy, Reem Elbeltagi
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, ‎Governmental Hospitals, Manama 12, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, The Royal College of Surgeons in Ireland, Busaiteen 15503, Muharraq, Bahrain
Adel Salah Bediwy, Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Alghrabia, Egypt
Adel Salah Bediwy, Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Reem Elbeltagi, Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
Co-first authors: Mohammed Al-Beltagi and Nermin Kamal Saeed.
Author contributions: Al-Beltagi M contributed to conceptualization, methodology, data collection, writing—original draft, and supervision; Saeed NK contributed to literature review, data analysis, writing—review and editing, and critical revision of the manuscript; Bediwy AS contributed to methodology, validation, manuscript revision, and contribution to clinical insights; Elbeltagi R contributed to data curation, writing—review and editing, and assistance in structuring the manuscript. All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this work.
PRISMA 2009 Checklist statement: This systematic review complies with the PRISMA 2009 guidelines, and the completed PRISMA checklist is provided in the supplementary materials.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MD, PhD, Professor, Chief Physician, Department of Paediatrics, Faculty of Medicine, Tanta University, 1 Hassan Radwan Street, Tanta 31511, Alghrabia, Egypt. mbelrem@hotmail.com
Received: December 18, 2024
Revised: February 24, 2025
Accepted: March 18, 2025
Published online: June 20, 2025
Processing time: 119 Days and 21.9 Hours
Abstract
BACKGROUND

Malnutrition and epilepsy share a complex bidirectional relationship, with malnutrition serving as a potential risk factor for epilepsy development, while epilepsy, in turn, often exerts profound effects on nutritional status. Nutritional interventions have emerged as a critical adjunctive approach in epilepsy management.

AIM

To explore the multifaceted associations between malnutrition and epilepsy, structured into three primary sections: (1) Elucidating the impact of malnutrition as a risk factor for epilepsy onset; (2) Examining the reciprocal influence of epilepsy on nutritional status, and (3) Evaluating diverse nutritional interventions in the management of epilepsy.

METHODS

A systematic search was conducted across PubMed, Scopus, and Web of Science databases utilizing defined keywords related to malnutrition, epilepsy, and nutritional interventions. Inclusion criteria encompassed various study types, including clinical trials, animal models, cohort studies, case reports, meta-analyses, systematic reviews, guidelines, editorials, and review articles. Four hundred sixteen pertinent references were identified, with 198 review articles, 153 research studies, 21 case reports, 24 meta-analyses, 14 systematic reviews, 4 guidelines, and 2 editorials meeting the predefined criteria.

RESULTS

The review revealed the intricate interplay between malnutrition and epilepsy, highlighting malnutrition as a potential risk factor in epilepsy development and elucidating how epilepsy often leads to nutritional deficiencies. Findings underscored the importance of nutritional interventions in managing epilepsy, showing their impact on seizure frequency, neuronal function, and overall brain health.

CONCLUSION

This systematic review emphasizes the bidirectional relationship between malnutrition and epilepsy while emphasizing the critical role of nutritional management in epilepsy treatment. The multifaceted insights underscore the need for a holistic approach to addressing nutritional aspects alongside conventional epilepsy management strategies.

Keywords: Epilepsy; Nutritional management; Seizure disorders; Antiepileptic drugs; Minerals; L-carnitine; Vitamins; Omega-3; Gut microbiota

Core Tip: This systematic review underscores the intricate relationship between nutrition and epilepsy, emphasizing the bidirectional impact of malnutrition on seizure susceptibility and the potential of tailored dietary interventions to improve epilepsy management. Through systematic search and analysis of various studies, the review highlights malnutrition as both a risk factor for epilepsy onset and a consequence of epilepsy, underscoring the importance of nutritional interventions in epilepsy management. While nutritional strategies such as ketogenic diets and medium-chain fatty acids offer promising benefits, their implementation is challenged by factors including patient compliance, resource allocation, and healthcare system support. The review calls for further research to elucidate the mechanisms underlying these interventions and highlights the need for a personalized, multidisciplinary approach to integrate nutrition into epilepsy care effectively.