The ketogenic diet[1] remains a valuable option for patients with intractable childhood epilepsy and, particularly, epileptic encephalopathies. The success of ketogenic diet on seizure outcome provides some insight into epileptogenesis and anticonvulsant action. Estimates indicate that, overall, complete cessation of all seizures occurs in 16% of patients, a greater than 90% reduction in seizures occurs in 32%, and a greater than 50% reduction in seizures occurs in 56%. It is said that 40–50% of those starting the diet
will have a greater than 50% reduction in seizures after 12 months. Parents also report improvements in their child's behavior and attention. A concomitant reduction in antiepileptic drugs is often possible. The ketogenic diet is the first-line therapy in patients with deficiencies in the GLUT-1 glucose transport, where glucose cannot be transported into the cerebrospinal fluid for use by the brain; the ketogenic diet is also useful in those with pyruvate dehydrogenase (E1) deficiency for the treatment of seizures due to glucose transporter protein deficiency.[2]
Classic ketogenic diet (Johns Hopkins Hospital protocol): The ketogenic diet used at the Johns Hopkins Hospital's pediatric epilepsy center is commonly considered the standard or classic form of this diet. The usual protocol for children between the ages of 3 and 12 years provides a ratio of four parts of fat to one part of protein and carbohydrates combined. The protocol followed in different countries is shown in Table 1.[3]