Measuring and Interpreting Ketosis and Fatty Acid Profiles in Patients on a High-Fat Ketogenic Diet

Despite over 80 yr of clinical experience with high-fat ketogenic diets (KDs) in the treatment of refractory seizures, we do not understand their anticonvulsant mechanism. In addition, it is difficult to monitor the efficacy of the diet and predict seizure outcome. Patients usually follow the diet for up to 3 mo before deciding whether to continue with it (1). Like many aspects of the KD, this 3-mo “trial period” has been set arbitrarily. There are no clear scientific predictors of which patients will and will not eventually respond to the diet. Unfortunately, without reliable markers of seizure outcome, we cannot adequately predict seizure response or which patient will benefit from the diet.