Epilepsy

María Magdalena Vaccarezza et al. (2026) · PloS one

This systematic review with meta-analysis pooled 17 randomized controlled trials of ketogenic diet therapies (KDTs) for drug-resistant epilepsy, meaning epilepsy that keeps causing seizures after two or three appropriately chosen antiseizure medications have failed. About 30% of people with epilepsy fall into this group. KDTs are high-fat, low-carbohydrate, adequate-protein diets that shift the body toward burning fat and producing ketone bodies, which are fat-derived fuel molecules that may calm brain activity and support neuron energy metabolism. Several forms exist: the classical ketogenic diet, the medium-chain triglyceride (MCT) diet, the modified Atkins diet with unrestricted protein, and the low glycemic index treatment. A 2020 Cochrane review left the evidence uncertain, and this update added newer trials. Eleven trials enrolled children and six enrolled adolescents and adults, with follow-up of up to 24 months. In nearly all trials, a ketogenic diet was compared with usual care, most often an added medication. The authors searched four databases in February 2024 and again in June 2025, screened 1,193 unique records in duplicate, and pooled results as relative risks (RR) using random-effects models. Study bias was rated with the Cochrane RoB 2 tool, and confidence in each result was graded from high to very low using GRADE. In children, a 50% or greater drop in seizures was far more likely with KDT (RR 4.06, meaning roughly four times the likelihood; 49.7% versus 12.2%, or 37 more children per 100). A 90% or greater drop was borderline (RR 1.74, 95% CI 1.00 to 3.03). Adverse events were similar to usual care (RR 1.03), and dropout was not significantly different (RR 1.64, 95% CI 0.88 to 3.07). In adolescents and adults, 50% or greater seizure reduction was also more likely (RR 7.73, which translates to 16 more per 100), with moderate certainty. Near-complete seizure control (RR 13.00, with a very wide interval of 0.74 to 226.98), side effects and dropout could not be judged because of very low certainty. Reported side effects were mainly gastrointestinal and resolved when the diet stopped. Quality of life findings were mixed: one infant trial found small differences favoring medication in temperament and peer relationships, while parents in another trial reported improved alertness and sleep. The authors interpret the findings as a clinically meaningful benefit for moderate seizure reduction, strongest in children. Certainty was limited by the impossibility of blinding a diet, small event counts and high heterogeneity for some outcomes. Most trials came from high-income countries, which may limit generalizability, and publication bias could not be excluded. No trial reported hospitalizations, status epilepticus or survival. The authors call for better evidence on safety, adherence, cognition and quality of life.

Monika Kujawska et al. (2019) · Journal of ethnobiology and ethnomedicine

This historical review examined Bryonia alba (white bryony), a vine in the cucumber family, tracing its use across northern and central-eastern Europe from antiquity through the twentieth century. The authors, an ethnobiologist and an ethnologist, worked from written and oral sources rather than a clinical study, covering Sweden, Denmark, Germany, Poland, Belarus, Ukraine, Romania and the Balkans. White bryony's root closely resembles the root of mandrake (Mandragora officinarum), a plant with an extensive European magical and medicinal reputation; the paper's central finding is that this resemblance let bryony function as mandrake's cheaper stand-in, inheriting much of its folklore in the process. Rather than enrolling participants, the authors searched historical floras, pharmacopoeias, ethnographic monographs, and travel accounts for every mention of the plant, then sorted findings into categories: ritual and folk-belief use, food, folk and historical medicine, ethnoveterinary practice, and ornamental planting. They cross-checked, where sources allowed, whether a given account referred to B. alba or its close relative B. dioica, and separated practices documented only in printed herbals ("booklore") from those recorded as living oral tradition passed between households. Across independent sources, root preparations were repeatedly recorded for oedema (fluid swelling, called dropsy at the time), convulsions and epilepsy, intestinal worms, wounds, and rheumatic pain — a 1792 Swedish account describes juice collected from a hollowed-out root curing oedema and treating worms, convulsions and headache, while twentieth- and twenty-first-century accounts from Serbia and Kosovo describe the same root used as a purgative, diuretic and topical anti-rheumatic agent. The authors cite phytochemical literature attributing these effects to cucurbitacins (bitter plant compounds), also linked elsewhere to antitumor activity, while stating plainly that historical claims for epilepsy specifically lack sufficient supporting study. Toxicity is dose- and season-dependent: freshly harvested summer root contains the more toxic cucurbitacin I, and the berries carry a cited lethal dose of roughly 15 for a child and 40 for an adult. The authors report that medicinal use had become obsolete across Scandinavia, Germany and western Slavic regions by the twentieth century, surviving only in isolated Balkan communities in Serbia and Kosovo. The authors present this decline as an unusual case: a plant of substantial historical medicinal and magical importance that today survives mainly as an ornamental garden relic or, in North America, as an unrelated invasive weed. Because the review synthesizes historical and ethnographic records rather than testing the plant directly, it offers no controlled data on safety or effectiveness, and the authors themselves flag some recorded folklore as possibly the invention of root sellers rather than genuine tradition. Future work, the authors suggest, could extend this same source-based method to B. dioica across German-, Latin- and Celtic-speaking Europe.