The ketogenic diet (KD) is an adjunctive treatment for CYE with refractory epilepsy that dates back to 19216. A true KD is high fat, low carbohydrate and induces ketone body production through fat metabolism to induce a fasting, ketogenic state in the body. For CYE from whom the diet is indicated, “20-40% of those treated with the KD reportedly showed a >90% reduction in seizure frequency, and a further 20%–60% showed a >50% improvement”7. Studies have shown that “30%-60% of patients with drug resistant epilepsy who use the KD have at least a 50% reduction in seizure frequency at 6 months”7.
The KD diet is a combination of the classic ketogenic diet, medium chain triglyceride (MCT) diet the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT)6:
It is considered the first line of treatment for6:
KD has shown good efficacy, but is not considered the first line of defense for:
The KD is considered part of a medical management plan and may work on select CYE that continue to have seizures despite appropriate medical treatment8. A KD should not be attempted without medical supervision; CYE who are treated with the KD should have care through an epilepsy center specializing in the diet.
Ketogenic Diet Side Effects
Patient monitoring for dehydration and metabolic disturbances (ketoacidosis and electrolyte imbalances) is indicated and adverse events from the KD may include kidney stones, constipation, elevated cholesterol, and bone demineralization after prolonged periods of diet adherence7,8. A strict restriction of candy and sweets can prove difficult for both the CYE and the family. Children on a KD must be checked by the pediatric neurologist and registered technician to monitor for nutritional deficiencies, growth and diet adherence9,10. Follow-up visits to measure height and weight are indicated, along with blood and urine test.
Special considerations need to take place regarding the implementation of the diet and children with comorbidities.