Ketogenic Therapy: First-Line Management of Intractable Seizures in Children

Over the last 20 years the ketogenic diet has become popular for reducing or eliminating intractable seizures in children. The diet has been shown effective in prospective and retrospective observational studies in which more than half of the patients had a greater than 50% reduction in or absence of seizures after 3 months on the diet.^1–4  Anecdotal reports of starvation reducing the frequency of seizures exist throughout history, but the first scientific accounts of a dietary approach to seizure management were not published until the early 20th century.⁵  Since then, carbohydrate-restricted, high-fat diets designed to mimic the metabolic response to fasting have been used to treat refractory and intractable epilepsy. The traditional form of the diet has been most successful in patients with atonic, myoclonic, or mixed seizures, as seen in Lennox-Gastaut syndrome. The ketogenic diet also has been used for treatment of infantile spasms, severe...