Efficiency of the ketogenic diet: treatment of refractory childhood epilepsy

This review reports on the past, current and potential future developments in aspects of the ketogenic diet in epilepsy treatment for children who have refractory epilepsy (uncontrolled seizures after having tried at least two anti-epileptic drugs). The ketogenic diet is based on putting the body into ketosis, so that is uses ketones rather than glucose for the energy in the brain. The diet commonly uses a 4:1 ratio of fat: carbohydrate. Looking at mostly retrospective or prospective studies it was shown on average at 6 months on the diet, 46% of children had a >50% decrease in the number of seizures (clinically significant). This is similar to results seen in anti-epileptic drugs. Some children on the diet also became seizure free. More randomised controlled studies should produce further evidence to support use of the ketogenic diet. The side effects shown are limited and can be reduced by modification of the diet in comparison to anti-epileptic drugs which can have severe cognitive side effects. The marked reduction of seizures while on the diet is maintained after being taken off the diet. The review concludes that there should be a recommendation for the ketogenic diet to be offered as a primary option alongside drugs and surgery when trying to treat childhood epilepsy.