Ketogenic Diet as a Treatment for Refractory Epilepsy

Recent advances in the understanding of the causes of epilepsy have resulted in an increased interest in treatment of this disorder in the past 30 years. With the introduction of more effective anti-epileptic drugs (AED), and genetic, molecular and imaging innovations, epilepsy can be treated effectively in the majority of cases. Although dietary therapy as a means to treat epilepsy has become less popular nowadays with the advent of new AEDs, it is still widely used for children with refractory seizures who are not responding to other treatment or who have serious adverse reactions to AEDs. The most popular diet in the treatment of epilepsy is the ketogenic diet, which has been used for more than 80 years. Even though there are not clearly defined guidelines as to how the diet is to be administered and sustained, there is no doubt as to the efficacy of this treatment. Despite the fact that there has been a long history of its use, much remains to be learned about the diet, including mechanisms of action and the biochemical basis of its therapeutic affects. Understanding why the diet is effective may allow for the development of new therapies. Epilepsy is a general term used for a group of disorders and is typically characterized by the occurrence of at least two unprovoked seizures (Hauser, Rich, Lee, Annegers, & Anderson, 1998). Seizures result from abnormal discharge of neurons in the brain. The type of seizure and its clinical manifestations are dependent on the extent of abnormal cortical neuronal discharge and the location of the discharge. Depending on the part of the brain that is affected, the surge of neuronal impulses may have an effect on a person's state of consciousness and cause intractable movements of the body, or other symptoms. For example, if the burst of electrical energy were located in the visual cortex, patients would experience symptoms involving visual experiences. Epilepsy affects 1% of the general population and is the most common neurological disorder in children (Persad, Thompson, & Percy, 2005).