Abstract

Despite a wide array of anti-epileptic drugs and the option of surgery, one-third of children and adults with epilepsy continue to suffer from drug-resistant seizures. Many of these patients may benefit from a ketogenic diet, a non-pharmacologic therapy proven to improve seizure control in epilepsy. Ketogenic diets aim to mimic the metabolic profile of fasting, and probably improve seizure control through a variety of mechanisms that collectively stabilize synaptic function. Although many similarities exist with regards to patient selection, patient preparation, and diet implementation in children compared to adults, there are also important differences. The most conspicuous challenge to the more widespread use of ketogenic diets in children and adults with epilepsy is a lack of access to ketogenic services in many regions of the world. Moreover, the culinary and social restrictions associated with conventional ketogenic diets pose a significant barrier to their use in adults.

Keywords: ketogenic, diet, children, adults, epilepsy

## 1. Introduction

Epilepsy is defined by recurrent, spontaneous seizures arising from hyperexcitable neurons in the brain. Yet despite a wide array of anti-epileptic drugs and the option of surgery, approximately one-third of children and adults with epilepsy continue to experience drug-resistant seizures [1]. Many of these patients may be candidates for a ketogenic diet, a well-established, non-pharmacologic therapeutic option proven to improve seizure control in epilepsy [2, 3].

The origins of ketogenic diets derive from the ancient practice of fasting [4], widely acknowledged as effective in treating epilepsy since the 5th century BC; indeed, until the 19th century, epilepsy was believed to be a disease of "eating too much" [5]. Depending on a person's body fat stores, fasting can be maintained for a considerable length of time (the record for a single continuous fast is 382 days) [6]. However, since everyone must eventually eat, fasting is not a feasible long-term solution for seizure control in epilepsy.

In 1921, Wilder addressed this problem by developing a high-fat, lowcarbohydrate diet designed to mimic the metabolic profile of fasting [4]. The highfat, low-carbohydrate nature of the diet elevated blood ketones and lowered blood glucose levels, producing a metabolic profile similar to that of a multi-day fast. Unlike fasting, Wilder's diet provided adequate long-term nutrient intake, thus preventing malnutrition and promoting healthy long-term growth and development. Since the diet increased hepatic ketogenesis, it became known as a "ketogenic diet."
