Unless mentioned, all evidence is Class IV. Published in , the first KD trial included 51 children who were enrolled at 7 sites. In modern times, as early as , Guelpa and Marie mention the effect of dietary manipulation on epilepsy Guelpa and Marie Nat Med ; 21 — Nutritionists, nurses, 3 months for patients receiving the classic pharmacists, hospitalists, food service ketogenic and MCT diets when compared to personnel, pediatric and family physicians, the group on a regular diet. Less clear is what happens to those who have reduced seizures but not seizure freedom, she said. Fasting should be considered optional, recognizing that the majority of this consensus group no longer prescribes fasting at KDT onset.
Ketogenic dietary therapies KDTs are established, effective nonpharmacologic treatments for intractable childhood epilepsy. For many years KDTs were implemented differently throughout the world due to lack of consistent protocols. Now one decade later, the organizers and authors of this guideline present a revised version with additional authors, in order to include recent research, especially regarding other dietary treatments, clarifying indications for use, side effects during initiation and ongoing use, value of supplements, and methods of KDT discontinuation. Ketogenic diets should be used in children after 2 antiseizure drugs have failed, and for several epilepsy syndromes perhaps even earlier. There are 4 major ketogenic diets, and the one chosen should be individualized based on the family and child situation. Flexibility in the initiation of ketogenic diets is appropriate, with fasting and inpatient initiation optional. Children should be seen regularly by the ketogenic diet team, along with labs and side effect monitoring at each visit. The classic ketogenic diet KD has been used continuously since
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It has been used as an earlier treatment option for infantile spasms, with some promising results. The diet is very restrictive and does not provide adequate vitamins and nutrients for optimal growth. Thus, all patients on the ketogenic diet are required to take daily vitamin and mineral supplements in order to maintain optimal nutrition. The most common side effects associated with starting the diet include nausea and vomiting. The most common side effects associated with long-term therapy on the diet include constipation and reflux. The risk of kidney stones is increased in individuals on the ketogenic diet. The modified Atkins diet does not restrict calories, protein, or fluids, but does encourage a high-fat diet while limiting the total daily grams of carbohydrate. It also allows for higher content of protein, and encourages a high-fat content of the diet to supply energy demands.