Abstract

The ketogenic diet (KD) is an established, effective nonpharmacologic treatment for intractable childhood epilepsy. In addition, it is the first-line treatment for some metabolic disorders, such as glucose trans¬porter 1 deficiency syndrome. It requires close monitor¬ing of growth and laboratory param¬eters. Therefore, an ad¬equate knowledge of the diet is essential for every pediatrician caring for these children. KD’s mechanisms of action in con¬trolling seizures remain under active research, but several theories have been proposed. In December 2006, The Charlie Foundation commissioned a panel comprised of 26 pediatric epileptologists and dietitians from nine countries with particular expertise using the KD. This group was created in order to create a consensus statement regarding the clinical management of the KD. This article will discuss the mechanisms of a keto¬genic diet’s antiseizure action, its clinical indications, and its contraindications. The steps involved in patient selection, pre-KD counseling and evaluation, KD types selection, implementation, supplementation, monitoring, and management of its side effects. The combined efforts of pediatric neurolo¬gists, pediatricians, and dieticians in monitoring children on KD are essential to the success of KD therapy and to the prevention, recognition, and treatment of its side effects. This review provides general pediatricians with the necessary skills to pro¬vide comprehensive care of children using the ketogenic diet and counsel their families and caregivers.