Several dietary therapies have been used in refractory seizures associated with LGS. Rare children may have a specific underlying metabolic defect, and if so, will need to be on a specific diet. However, for other children with intractable seizures and LGS, the ketogenic diet may be helpful. Before starting this therapy, the family is usually given information on the ketogenic diet and directed to a website (www.charliefoundation.org or the columns of Dr. Eric Kossoff here on epilepsy.com) so that they may explore this therapy and see if they believe the child and other family members could cooperate with this therapy. This particular therapy, more than any others, is highly dependant on the home environment to be successful. This is a strictly regulated medical therapy. The child can only eat what is only allowed on the ketogenic diet, with each meal being weighed and measured. The family can meet with the dietician and be given a sample menu that may help them in their decision to see if they think that the child will be able to perform this therapy. The ketogenic diet is typically effective for multiple seizure types but most effective for the drop attacks. Typically, the family should look at the ketogenic diet as a trial for 4-6 weeks initially. At the end of this time, they will know if they are seeing a response to the diet or not. If they are seeing a response, the family will continue the ketogenic diet and other therapies will be modified. If no response is seen, then further treatment with the ketogenic is not often helpful.

To initiate the ketogenic diet, the child may be hospitalized for initiation. This allows for changes in medications if needed and for the dietician to prepare a meal plan for the child. The child is then seen as follow up in 3-4 weeks, and the response to the diet is determined, and a decision is made if the child will continue on the diet or not.

The benefits of the ketogenic diet include a reduction in seizures, a potential decrease in the number of medications that the child is taking, a potential improvement in the child’s behavior and less drowsiness.

If successful, the ketogenic diet is usually maintained for at least two years but can be maintained for longer periods of time if necessary. Additionally, other modifications of the diet are available. The diet can be used in combination with other therapies, either medications or surgical.

Author: James Wheless, M.D.
Topic Editor: Robert Fisher, M.D., Ph.D.
Last Reviewed: 8/7/09