There are four types of metabolic therapies used for the reduction of seizures including These are classic ketogenic diet, the medium chain triglyceride (MCT) diet, the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT).47 The ketogenic diet has been used as a therapeutic alternative to antiepileptic drugs (AEDs) for the treatment of refractory epilepsy and usually reserved for young patients with difficult to control seizures. The ketogenic diet is a special high fat, low carbohydrate diet typically in a ratio of 4:1 or 3:1. It gets converted to ketone bodies (beta -hydroxy butyrate or aceto acetate) and also increases GABA activity in the brain.53 In MCT more carbohydrates and proteins can be consumed for every gram of fat and there is no limit on the amount of protein consumed or the total number of calories consumed per day. MCT diet is more successful in the treatment of children patient due to its acceptability as compared to adults. The MAD diet has a fraction of 1 gram of fat for every gram of carbohydrates plus protein and is less restrictive than other two fat diets. The low glycemic index treatment (LGIT) restricts carbohydrate intake to food items with a glycemic index of less than 50 at 40–60 grams per day.47,54–56 Dietary therapies show some side effects like constipation, acidosis, kidney stones, temporary hypercholesterolemia and hunger. But in-addition to showing high levels of efficacy similar to many AEDs, the dietary interventions are generally quite
tolerable and demonstrate the effectiveness in a relatively short time period.47 The possible mechanisms of protection by dietary therapies is because of difference in processing of ketonebodies in brain as shown in Fig. 2E than in liver shown in Fig. 2D.