Dietary Therapy in Epilepsy

The ketogenic diet is a high-fat, low-carbohydrate, protein sufficient diet that is utilized for the treatment of intractable epilepsy. Proposed mechanisms include alteration in mitochondrial function, direct effects of ketone bodies on neuronal function and neurotransmitter release, antiepileptic effects of fatty acids, glucose stabilization, inhibition of mammalian target of rapamycin and increasing membrane hyperpolarization either by increasing gamma aminobutyric acid or decreasing glutamate, adenosine or norepinephrine. In addition, ketone bodies may also provide neuroprotective effects. Initiation and maintenance of dietary therapy for epilepsy requires close partnership between the neurologist with expertise in ketogenic diet use, and an experienced ketogenic dietician. The various forms of the ketogenic diets are nutritionally incomplete, and supplementation is essential in all patients. There are few contraindications to the ketogenic diet, other than specific metabolic disorders. However, the restricted nature of the diet makes compliance a continued issue for many patients, especially adults and adolescents.