By Eric Kossoff, MD

The ketogenic diet has increased in popularity since the early 1990s, but also there has been a dramatic increase in research. In perhaps the best demonstration to date, the January 2007 issue of Epilepsia was devoted to pediatric epilepsy, with a special emphasis on the ketogenic diet! In this prominent epilepsy journal, any article about the ketogenic diet warrants attention, as such we are pleased that an entire issue was devoted to the topic.

The articles published include:

1. “Clinical Aspects of the Ketogenic Diet.” This is a review of the clinical use of the ketogenic diet by Drs. Adam Hartman and Eileen Vining from Johns Hopkins Hospital.

2. “Anticonvulsant Mechanism of the Ketogenic Diet.” This is a review of the basic science mechanisms of action of the diet by Drs. Jong Rho and Kristopher Bough.

3. "Combined Ketogenic Diet and Vagus Nerve Stimulation: Rational Polytherapy?" Written by this author with members of six other epilepsy centers, in this article, the ketogenic diet in combination with VNS was evaluated retrospectively. It was found to be an effective combination. Interestingly, it worked typically within a month and it worked better using regular duty cycles of the VNS (30 seconds on, 5 minutes off). Although rarely used, this combination might be a good one.

4. "Safe and Effective Use of the Ketogenic Diet in Children with Epilepsy and Mitochondrial Respiratory Chain Complex Defects" by Kang, et al from South Korea. In this study, the worries about the use of the diet for children with mitochondrial disorders, claimed for years, is brought into question. Fourteen children were treated, 7 became seizure-free. The diet was safe in these children as well.

5. "Use of a Modified Atkins Diet in Intractable Childhood Epilepsy," Kang, et al, describes the use of this diet (also highlighted on epilepsy.com) in a prospective study of 14 children. The diet was effective and well-tolerated and, unlike previous studies of the modified Atkins diet, it was found that efficacy was tied together with level of ketosis.

6. "Discontinuing the Ketogenic Diet in Seizure-Free Children: Recurrence and Risk Factors" by Martinez, et al from Hopkins. In this study, 66 children who became seizure-free on the diet and eventually then stopped the diet were followed to see if they remained seizure-free. Most did remain seizure-free with only 13 (20%) having seizures return, often while weaning off the diet. Seven were able to get their seizures back under control, and not all needed to restart the diet in order to do so. Interestingly, children with epileptiform activity on their EEGs, abnormal MRIs, or tuberous sclerosis prior to stopping the diet were more likely to have their seizures return.

7. "Ketogenic Diet Improves Sleep Quality in Children with Therapy-resistant Epilepsy" by Hallbook, et al from Sweden. This study evaluated 18 children with epilepsy treated with the ketogenic diet and found that daytime sleep was reduced, REM sleep was increased, and stage 2 sleep was increased. The authors believed that the improvement in REM sleep also improved quality of life.

8. "Vitamin D Status in Children with Intractable Epilepsy, and Impact of the Ketogenic Diet" by Bergqvist, et al from Philadelphia. Forty-five children were prospectively evaluated with Vitamin D levels on the diet. The majority of these children started out with low Vitamin D levels and actually saw an increase in levels on the diet over 3 months -- likely as a result of the new supplementation typically used with the diet. However, over the next 12 months, vitamin D levels decreased steadily.

It is apparent that the future of research for the ketogenic diet is clearly a bright one. If you wish to read abstracts of these articles, you may do so by going to the following link: http://www.blackwell-synergy.com/toc/epi/48/1

Topic Editor: Eric Kossoff, MD
Last Reviewed: 1/31/07