Ketogenic diet in the management of childhood epilepsy.

The ketogenic diet has been used for the treatment of epilepsy in children for almost 100 years. Originally, it was determined that individuals with seizures found benefit from starvation; subsequently a diet was proposed which was high in fat content, the breakdown of fat for energy producing ketones and therefore mimicking starvation(1). This was subsequently found to be effective in treating recurrent seizures. Many open label studies over the years suggested considerable benefit could be achieved in children with epilepsy; it went out of favor with the advent of anticonvulsants but further interest in the 1990s led to an increase in evaluation and use. However, despite the belief in its efficacy, repeatedly systematic reviews commented on the lack of randomized controlled data(2,3). It was only last year that the first randomized controlled trial was published, defining without doubt the efficacy of the ketogenic diet in children with drug resistant epilepsy(4).