Ketogenic diet in the treatment of epilepsy

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By Marcio A Sotero de Menezes MD and Jennifer L Schoenfeld ARNP

Key Points

  • The ketogenic diet is a medical treatment for intractable epilepsy and should only be administered under direct medical supervision.
  • The ketogenic diet is an effective treatment for seizures that are refractory to antiepileptic drugs. It has been used as an earlier treatment option for infantile spasms, with some promising results.
  • The ketogenic diet serves as an effective treatment option regardless of seizure type, seizure syndrome, and age.
  • If a patient has some improvement in seizures on the ketogenic diet, but still continues to have seizures, fine-tuning the diet by adjusting the calories or the ratio may provide additional seizure control.
  • The ketogenic diet is not considered a “healthy” or “all-natural” therapy for seizures. The diet is very restrictive and does not provide adequate vitamins and nutrients for optimal growth. Thus, all patients on the ketogenic diet are required to take daily vitamin and mineral supplements in order to maintain optimal nutrition.
  • The ketogenic diet does have potential side effects, as do all treatment options for seizures. The most common side effects associated with starting the diet include nausea and vomiting. The most common side effects associated with long-term therapy on the diet include constipation and reflux. The risk of kidney stones is increased in individuals on the ketogenic diet.
  • The modified Atkins diet is a newer, more liberal version of the ketogenic diet that has shown promising results, especially for teenagers and adults interested in trying a diet therapy option. The modified Atkins diet does not restrict calories, protein, or fluids, but does encourage a high-fat diet while limiting the total daily grams of carbohydrate.
  • The ketogenic diet, the modified Atkins diet, and the low glycemic index treatment all require regular medical care, with frequent neurologic and dietary follow-up management.