Practical Use of the Ketogenic Diet in Childhood Epilepsy

The ketogenic diet (KD) is a high fat, low carbohydrate diet that has been used for intractable childhood epilepsy since the early 1920s. After the resurgence of the ketogenic diet in the mid 1990s, it has been used worldwide for the treatment of refractory pediatric epilepsy. Thus the ketogenic diet is an established, effective nonpharmacologic treatment for intractable childhood epilepsy. Over the past decade the role of the ketogenic diet in the treatment of intractable epilepsy has became evident from the explosion of interest and publications available, as well as the increased number of epilepsy centers that offer the ketogenic diet. However, the ketogenic diet is not yet a convenient therapy, especially because the customary diets of Asian countries contain substantially less fat than the traditional Western diets. Therefore, recent research endeavor to achieve a safer and more convenient dietary treatment for refractory pediatric epilepsy. Recent consensus of ketogenic diet by expert’s opinion provided guideline in using the diet. Suggested protocols, which include changes to the applicable ages, seizure types, and etiologies, the initiation of the diet, changes in the ratio of constituents to reduce the fat content, the duration of the diet, and revised formulae, such as ketogenic milk or the allliquid ketogenic diet, have attempted to extend the indications of the ketogenic diet and increase its tolerability. Physicians should also be aware of the various complications of the diet. Less restrictive ketogenic diet including a modified Atkins and low-glycemic-index diets have also been clinically tried with comparable efficacies. This chapter will provide practical recommendations to guide the management of the ketogenic diet in childhood epilepsy and give a review on the current state of ketogenic diet.