The ketogenic diet (KD) is a high-fat, adequate protein, very low carbohydrate diet that is both calorie and fluid restricted and carefully calculated by a ketogenic diet-trained dietitian to create and maintain ketosis 2 Typical foods eaten include butter, eggs, cheese, heavy whipping cream, canola and olive oils, mayonnaise, green vegetables, chicken, hot dogs, and ground beef Sugar-free and carbohydrate-free snacks can be incorporated to help make the KD more palatable
Although the KD's exact mechanism of action remains somewhat unclear, and is probably multifactorial, in nearly 100 retrospective and prospective studies since its introduction in 1921, it has been clearly demonstrated as effective. 5,19 The KD causes a >50% reduction in seizures in approximately 55-60% of the children who begin it by 6 months, and seizure reduction is often maintained long term 4,5 Despite media-reported stories of cases of dramatic responses, seizure freedom only occurs in 10-15% of children . However, considering the very intractable epilepsy these children have at the time of KD onset, many epileptologists believe that the diet is more likely to be effective than an additional antiepileptic trial after 3-4 antiepileptic drugs have been unsuccessful, especially for generalized epilepsies
The KD is started gradually in a child as an inpatient, typically following a 24- to 48-hour fasting period designed to rapidly induce ketosis .2 It is provided in a typically 4:1 or 3:1 ratio (of fat to protein and carbohydrate combined) and is slightly calorie and fluid restricted The fasting has been demonstrated in several retrospective and prospective studies to be unnecessary for long-term control; however, it appears to lead to a more rapid seizure improvement in many children . 18 During the 4- to 5-day-long admission period, families and children are educated for several hours per day regarding the KD attributes and its outpatient management. Most centers still believe that the admission period is crucial for education and subsequent long-term diet adherence
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