Epilepsy and the Ketogenic Diet

John M. Freeman, MD

Disclosures

November 04, 2008

Question

Can you please provide a simple feeding schedule for the ketogenic diet? And for what type of epilepsy is the ketogenic diet helpful?

Response from the Expert

Response from John M. Freeman, MD
Professor Emeritus, Neurology and Pediatrics, Johns Hopkins University, Baltimore, Maryland

The ketogenic diet is an effective therapy for all types of difficult-to-control seizures. It has been mainly studied in patients who have failed therapy with 2 anticonvulsant medications, and it is particularly helpful for the myoclonic and Lennox-Gastaut types of seizures, which are the most refractory to current medications.[1]

There are several different forms of the ketogenic diet, including the classic diet[1] and, more recently, a modified Atkins-like diet.[2] They all are approximately equally effective. At Johns Hopkins, we have primarily used the classic ketogenic diet.

The diet schedule is fully described in our book, Ketogenic Diets for the Management of Epilepsy,[3] which provides detailed descriptions of the diet's calculations and some menus. The book will be helpful to physicians prescribing the diet, to dieticians supervising the diet, and to families implementing the diet.

Fasting for diet initiation may not be necessary, although it appears to hasten the diet's effectiveness. We currently fast children for only 24 hours. The diet is commonly used in a 4:1 ratio of fat to protein plus carbohydrate, but 3:1 ratios are often used in younger children (< 2 years) and adolescents. Gradual initiation of this high-fat diet over several days improves tolerance. General health and weight gain or loss must be carefully monitored. Supervision of the child by a dietician who is familiar with the diet is mandatory because serious complications can occur. Constipation and kidney stones are the diet's more common complications. Supplementation with vitamins and minerals is also mandatory.

With these cautions, the ketogenic diet appears well tolerated when it is effective, and appears to be more effective over longer periods than any of the currently available anticonvulsant medications.[1]

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