Indications and Contraindications of the Ketogenic Diet

Part of the Nutrition and Health book series (NH)


The ketogenic diet (KD) has historically been used in the treatment of medically refractory epilepsy. It is currently not recommended for new-onset seizures because antiepileptic drugs (AEDs) are easier to use and are effective in approx 70–80% of patients. The KD requires a significant commitment of time and effort by the patient, his or her family, the KD health-care team, and the institution that supports the KD program. Determining precisely when intractability occurs in a child with epilepsy continues to be a subject of discussion among epidemiologists (1–5). Generally, epilepsy centers will not offer the KD treatment until a patient has failed two or three standard AEDs. Most patients who start the KD have failed at least three times as many AEDs. The KD is not recommended to some patients until all other options have failed (6). Current treatments available to patients with intractable epilepsies include a plethora of conventional AEDs, the vagus nerve stimulator, epilepsy surgery, and the KD. The optimal hierarchy of these treatments in the course of intractable epilepsy should be continually reevaluated based on efficacy, side effects, and safety. For example, epilepsy surgery (the “gold standard” for lesional temporal lobe epilepsy) is often ineffective in nonlesional, nontemporal causes of epilepsy and may result in significant morbidity. The use of the KD prior to epilepsy surgery treatment in these patients has been suggested (7,8).


Ketone Body Inborn Error Ketogenic Diet Seizure Type Refractory Epilepsy 
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