2.2 Conventional ketogenic diets in epilepsy

To date, four major, "conventional" ketogenic diets are supported by published evidence in the treatment of children and adults with epilepsy (Table 2) [2, 3]. The primary difference between each diet lies in the ratio of fat to protein plus carbohydrate, described by weight or by calorie intake.

translating to a 1:1 ratio of fat to protein plus carbohydrate, although no set ratio is mandated; it may even approach a 4:1 ratio [2]. The MAD eases up on the protein and carbohydrate restrictions imposed by the CKD and MCT diet, and does not

The LGIT, roughly 40% fat by weight (60% fat by caloric intake), was introduced in the early 2000s as a treatment for epilepsy [25]. The design of the LGIT was based on the hypothesis that stable glucose levels contribute to the seizure control conferred by ketogenic diets. The LGIT allows for relatively liberal levels of protein and carbohydrate intake, emphasizing carbohydrates with glycemic indices

Unfortunately, many children throughout the world still lack access to a pediatric epilepsy center containing a specialized ketogenic service with both inpatient and outpatient management options [2]. Such a service should consist of a pediatric neurologist, nurse, dietitian, and ideally case managers, psychologists, social

Ketogenic diets in children are strongly indicated in drug-resistant epilepsy, two disorders of brain metabolism, and several other seizure disorders (Table 3) [2]. There is virtually no age restriction as to when the diet may be commenced; in fact,

In 2010, the International League Against Epilepsy (ILAE) defined drug-resistant epilepsy as the failure of adequate trials of two appropriately chosen, tolerated, and used anti-epileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom [28]. The drugs must have been appropriate for the seizure type, tolerated at therapeutic doses, and given a reasonable period of time

When drug-resistant epilepsy is declared, further anti-epileptic drug trials or epilepsy surgery may be helpful [30]. However, even after carefully excluding confounding factors and optimizing the drug approach, subsequent trials have only a slight (about 5%) chance of inducing seizure remission [31]. Surgery should always be considered in children with drug-resistant epilepsy, especially when a lesion concordant to the epilepsy is detected on imaging [30], but many children are not surgical candidates due to a generalized or multifocal epilepsy syndrome, or

When drug trials and surgery are no longer feasible, a ketogenic diet is indicated [2]. Numerous studies have demonstrated the efficacy and safety of using ketogenic diets to treat drug-resistant epilepsy in children, but until the previous decade there were no randomized controlled trials. Since 2008, four published randomized controlled trials have compared the efficacy of a ketogenic diet with continued medi-

cations or a placebo arm in children with drug-resistant epilepsy [32–35].

require food weighing.

workers, and pharmacists [2, 26].

3.1.1 Drug-resistant epilepsy in children

nonresectable location of ictal onset.

151

3.1 Selecting the right child for a ketogenic diet

less than 50.

2.2.4 The low glycemic index treatment (LGIT) diet

Ketogenic Diet Therapies in Children and Adults with Epilepsy

DOI: http://dx.doi.org/10.5772/intechopen.83711

3. Ketogenic diet therapies in children with epilepsy

infants younger than 2 years may be an ideal age group [27].

to work (at least 6 months) [29] before declaring drug resistance.
