Anticonvulsants, Neurology, psychiatry
Basic Facts About Keto Eating For Seizure Control
Mar
The ketogenic diet has emerged as a promising alternative treatment for individuals with epilepsy, particularly those who have not responded well to traditional anticonvulsant medications. By drastically reducing carbohydrate intake and replacing it with healthy fats, the ketogenic diet induces a metabolic state called ketosis, which has been shown to have significant seizure-reducing effects in many patients.
This article aims to provide a comprehensive overview of the ketogenic diet as a therapy for seizure control, exploring its history, mechanisms of action, efficacy, and practical considerations for implementation. We will delve into the various types of ketogenic diets, nutritional guidelines, potential side effects, and the importance of medical supervision throughout the process. By the end of this article, readers will have a better understanding of how the ketogenic diet works, its potential benefits and risks, and how to navigate the journey of using this dietary approach to manage epilepsy.
The Ketogenic Diet and Seizure Reduction
The ketogenic diet has a long history of use in the treatment of epilepsy, dating back to the 1920s[1]. This high-fat, low-carbohydrate diet is designed to mimic the metabolic effects of fasting, which has been observed to reduce seizure frequency in some individuals. By limiting carbohydrate intake and increasing fat consumption, the body enters a state of ketosis, where it primarily burns fat for fuel instead of glucose.
The exact mechanisms by which the ketogenic diet reduces seizures are not fully understood, but several theories have been proposed. One hypothesis suggests that the increased production of ketones, particularly beta-hydroxybutyrate, may have anticonvulsant properties[2]. Additionally, the diet may alter neurotransmitter levels, reduce oxidative stress, and modulate energy metabolism in the brain, all of which could contribute to its seizure-reducing effects.
Efficacy of the Ketogenic Diet for Different Seizure Types and Syndromes
The efficacy of the ketogenic diet varies depending on the type of seizure and epilepsy syndrome. Studies have shown that the diet is particularly effective for certain types of epilepsy, such as Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex[3]. In some cases, the ketogenic diet may be used as a first-line treatment, while in others, it is typically considered when multiple anticonvulsant medications have failed.
Comparison of the Ketogenic Diet to Other Epilepsy Treatments
While the ketogenic diet can be a powerful tool in managing epilepsy, it is not a one-size-fits-all solution. Anticonvulsant medications remain the primary treatment for most individuals with epilepsy, and other dietary therapies, such as the modified Atkins diet and the low glycemic index treatment, may be more appropriate for some patients. Surgery, vagus nerve stimulation, and other alternative therapies may also be considered in specific cases.
Limitations and Potential Side Effects of the Ketogenic Diet
Despite its potential benefits, the ketogenic diet has some limitations and may cause side effects. Common short-term side effects include gastrointestinal issues, such as constipation, diarrhea, and vomiting, as well as fatigue and low blood sugar. Long-term use of the diet may lead to nutrient deficiencies, kidney stones, and impaired growth in children. Regular monitoring by a healthcare team is essential to minimize risks and ensure the diet is well-tolerated.
| Pros | Cons |
|---|---|
| May reduce seizure frequency and severity | Requires strict adherence and careful planning |
| Can be effective when medications have failed | May cause short-term and long-term side effects |
| May improve overall quality of life | Can be difficult to maintain, especially for children |
| Non-pharmacological approach | Requires close medical supervision |
Initiating and Maintaining a Ketogenic Diet
Before starting a ketogenic diet for seizure control, it is crucial to consult with a neurologist and a registered dietitian experienced in managing epilepsy through dietary interventions[4]. The healthcare team will assess the individual’s medical history, seizure type and frequency, and overall health to determine if the ketogenic diet is an appropriate treatment option.
Calculating Individual Macronutrient Ratios and Calorie Needs
The classic ketogenic diet typically consists of a 4:1 ratio of fat to combined protein and carbohydrates, meaning that 80% of calories come from fat, 15% from protein, and 5% from carbohydrates. However, this ratio may be adjusted based on individual needs and tolerability[5]. A registered dietitian will calculate the appropriate macronutrient ratios and calorie needs based on the patient’s age, weight, height, and activity level.
Gradually Transitioning to a Ketogenic Diet
Transitioning to a ketogenic diet is typically done gradually over several weeks to minimize side effects and ensure the patient’s tolerance to the high-fat, low-carbohydrate intake. The healthcare team will provide a detailed meal plan and guidance on how to incorporate ketogenic-friendly foods into the diet while restricting carbohydrate-rich items.
| Week 1 | Week 2 | Week 3 | Week 4 | |
|---|---|---|---|---|
| Fat:Carb+Protein Ratio | 1:1 | 2:1 | 3:1 | 4:1 |
| % Calories from Fat | 50% | 67% | 75% | 80% |
Monitoring Ketosis and Adjusting the Diet as Needed
Regularly monitoring ketosis is essential to ensure the diet is working effectively. This can be done through daily urine ketone testing, blood ketone testing, or breath acetone analysis[6]. The healthcare team will review the results and make adjustments to the diet as needed to optimize seizure control and minimize side effects.
Strategies for Long-Term Adherence to the Ketogenic Diet
- Meal planning and preparation in advance
- Involving the entire family in the dietary changes
- Finding ketogenic-friendly substitutes for favorite foods
- Joining support groups or connecting with other families following the diet
- Regularly communicating with the healthcare team to address any concerns or difficulties
Long-term success with the ketogenic diet requires patience, dedication, and ongoing support from healthcare professionals and family members. By maintaining open communication and a positive attitude, individuals can effectively manage their epilepsy through this specialized dietary approach.
Ketogenic Diet Variations and Modifications
While the classic ketogenic diet is the most well-studied and commonly used version for seizure control, several variations and modifications have been developed to improve palatability, flexibility, and adherence. These alternative approaches may be more suitable for certain individuals based on their age, lifestyle, and medical needs[7].
Classic Ketogenic Diet (4:1 ratio)
The classic ketogenic diet, with its 4:1 ratio of fat to combined protein and carbohydrates, is the most restrictive but also the most effective version for seizure control. This high-fat, low-carbohydrate diet requires careful planning and monitoring to ensure adequate nutrition and maintain ketosis.
Medium-Chain Triglyceride (MCT) Diet
The MCT diet incorporates medium-chain triglycerides, a type of fat that is more easily converted into ketones, allowing for a slightly higher carbohydrate intake compared to the classic ketogenic diet. This variation may be more palatable and easier to follow for some individuals, but it can also cause gastrointestinal side effects[8].
| Classic Ketogenic Diet | MCT Diet | |
|---|---|---|
| Fat:Carb+Protein Ratio | 4:1 | 3:1 to 4:1 |
| % Calories from MCT | 0-10% | 30-60% |
| Carbohydrate Allowance | Very low | Slightly higher |
Modified Atkins Diet
The modified Atkins diet is a less restrictive version of the ketogenic diet, allowing for a higher intake of protein and carbohydrates. This approach may be more suitable for older children, adolescents, and adults who desire more flexibility in their food choices. While it may be less effective than the classic ketogenic diet, the modified Atkins diet can still lead to significant seizure reduction in some individuals.
Low Glycemic Index Treatment (LGIT)
The low glycemic index treatment focuses on consuming foods with a low glycemic index, which have a slower and more gradual impact on blood sugar levels. This approach allows for a higher intake of carbohydrates compared to the classic ketogenic diet but emphasizes complex carbohydrates over simple sugars. The LGIT may be appropriate for individuals who find the classic ketogenic diet too restrictive or have difficulty maintaining ketosis[9].
Combining the Ketogenic Diet with Other Treatments
In some cases, the ketogenic diet may be used in combination with other epilepsy treatments, such as anticonvulsant medications, vagus nerve stimulation, or surgery. The healthcare team will carefully monitor the individual’s response to the combined therapies and make adjustments as needed to optimize seizure control and minimize side effects.
Nutritional Considerations and Meal Planning
Implementing a ketogenic diet for seizure control requires careful attention to macronutrient sources and distribution to ensure the body receives adequate nutrition while maintaining ketosis. A registered dietitian experienced in ketogenic therapies will work closely with the individual and their family to develop a customized meal plan that meets their specific needs[10].
Macronutrient Sources and Distribution
On a ketogenic diet, the primary macronutrient sources are:
- Fat: High-fat foods such as avocados, nuts, seeds, olive oil, butter, and cream
- Protein: Moderate amounts of protein from sources like eggs, meat, fish, and cheese
- Carbohydrates: Very low intake of carbohydrates, primarily from non-starchy vegetables and limited amounts of fruits
The specific macronutrient distribution will depend on the chosen ketogenic diet variation and individual requirements.
Micronutrient Supplementation
Due to the restricted nature of the ketogenic diet, individuals may be at risk for certain micronutrient deficiencies. Common deficiencies include calcium, vitamin D, iron, and selenium[11]. The healthcare team will regularly monitor micronutrient levels and recommend appropriate supplements to prevent or address any deficiencies.
Hydration and Electrolyte Balance
Maintaining adequate hydration and electrolyte balance is crucial while following a ketogenic diet. The diet’s diuretic effect can lead to increased water and electrolyte losses, particularly during the initial adaptation phase. Strategies to promote hydration and maintain electrolyte balance include:
- Encouraging regular fluid intake
- Using salt liberally in food preparation
- Incorporating electrolyte-rich foods such as bone broth and leafy greens
- Considering electrolyte supplements as recommended by the healthcare team
Sample Meal Plans and Recipes
The registered dietitian will provide sample meal plans and recipes tailored to the individual’s specific macronutrient ratios and calorie needs. These resources will help ensure variety and palatability while adhering to the ketogenic diet guidelines. Some examples of ketogenic-friendly meals include:
- Scrambled eggs with cheese and avocado
- Grilled salmon with roasted low-carb vegetables
- Chicken salad with high-fat dressing and leafy greens
- Keto “fat bombs” made with coconut oil, nut butter, and low-carb sweeteners
Strategies for Dining Out and Social Situations
Following a ketogenic diet can be challenging in social situations and when dining out. However, with some planning and preparation, individuals can successfully navigate these situations[12]. Strategies include:
- Researching restaurant menus in advance and identifying keto-friendly options
- Communicating dietary needs to restaurant staff or hosts
- Bringing keto-friendly snacks or meals to social gatherings
- Focusing on the social aspects of the event rather than the food
By working closely with a registered dietitian and developing a comprehensive meal plan, individuals can ensure they are meeting their nutritional needs while successfully adhering to the ketogenic diet for seizure control.
Monitoring and Side Effect Management
Regular monitoring is essential for individuals following a ketogenic diet for seizure control to ensure the diet’s effectiveness, safety, and tolerability. The healthcare team, including the neurologist and registered dietitian, will closely monitor the individual’s progress and manage any side effects that may arise[13].
Tracking Seizure Frequency and Severity
Individuals or their caregivers should maintain a seizure diary to record the frequency, duration, and severity of seizures. This information will help the healthcare team assess the diet’s effectiveness and make any necessary adjustments. The goal is to achieve a significant reduction in seizure frequency and severity compared to baseline.
Monitoring Ketosis and Glucose Levels
Regularly monitoring ketosis is crucial to ensure the diet is working as intended. This can be done through various methods, including:
- Urine ketone testing (most common and cost-effective)
- Blood ketone testing (more accurate but requires finger pricks)
- Breath acetone analysis (non-invasive but less commonly used)
The healthcare team will provide guidance on the optimal range of ketosis and adjust the diet as needed. Blood glucose levels should also be periodically checked to prevent hypoglycemia[14].
Assessing Growth and Nutritional Status
Children following a ketogenic diet should have regular growth assessments, including weight, height, and body mass index (BMI) measurements. The registered dietitian will monitor the child’s growth and adjust the diet to ensure adequate nutrition for proper development. In adults, the focus will be on maintaining a healthy weight and preventing nutrient deficiencies.
Common Side Effects and Management Strategies
While the ketogenic diet is generally well-tolerated, some individuals may experience side effects, particularly during the initial adaptation phase. Common side effects include:
- Gastrointestinal issues (nausea, vomiting, constipation, diarrhea)
- Fatigue and lethargy
- Hypoglycemia
- Acidosis
- Kidney stones
- Micronutrient deficiencies
The healthcare team will provide strategies to manage these side effects, such as:
- Adjusting the diet’s macronutrient ratio or calorie intake
- Encouraging adequate fluid and electrolyte intake
- Prescribing medications to alleviate gastrointestinal symptoms
- Recommending micronutrient supplements as needed
Long-Term Follow-Up and Diet Duration
Individuals on a ketogenic diet for seizure control will require long-term follow-up with their healthcare team. The duration of the diet will depend on the individual’s response and seizure control. Some may continue the diet indefinitely, while others may gradually transition off the diet after a period of seizure remission[15]. The decision to discontinue the diet should be made in consultation with the healthcare team, considering factors such as seizure control, side effects, and quality of life.
By closely monitoring the individual’s response to the ketogenic diet and promptly addressing any side effects, the healthcare team can optimize the diet’s effectiveness and ensure the individual’s safety and well-being.
Special Populations and Considerations
While the ketogenic diet can be an effective treatment option for individuals with refractory epilepsy, certain populations may require special considerations and modifications to ensure safety and optimal outcomes.
Infants and Young Children
Infants and young children may be particularly sensitive to the ketogenic diet’s restrictive nature and potential side effects. The healthcare team will closely monitor growth, development, and nutrient intake to ensure the diet meets the child’s needs. Adjustments to the diet’s macronutrient ratio or supplementation may be necessary to support proper growth and development[16].
Adolescents and Adults
Adolescents and adults may face unique challenges when following a ketogenic diet, such as increased social pressure and difficulty adhering to the diet in various settings. The healthcare team will work with these individuals to develop strategies for maintaining the diet in social situations, such as eating out or attending events. Psychological support may also be provided to help manage stress and promote long-term adherence[17].
Pregnant and Breastfeeding Women
The safety and efficacy of the ketogenic diet during pregnancy and breastfeeding have not been well-studied. Pregnant women with epilepsy should work closely with their healthcare team to weigh the potential risks and benefits of the diet during this critical period. If the ketogenic diet is deemed necessary, close monitoring of maternal and fetal health is essential.Breastfeeding women should also consult with their healthcare team to ensure the diet is compatible with their nutritional needs and milk production.
Individuals with Comorbidities
Some individuals with epilepsy may have coexisting conditions that require special consideration when implementing a ketogenic diet. For example:
- Individuals with diabetes may need adjustments to their insulin or medication regimen to prevent hypoglycemia.
- Those with gastrointestinal disorders may require modifications to the diet’s fat sources or the use of digestive enzymes to improve tolerance.
- Individuals with a history of kidney stones may need additional monitoring and strategies to prevent stone formation, such as increasing fluid intake and citrate supplementation.
The healthcare team will assess each individual’s unique needs and develop a personalized plan to manage comorbidities while maintaining the diet’s effectiveness for seizure control.
Cultural and Religious Considerations
Cultural and religious factors may influence an individual’s ability to adhere to a ketogenic diet. Some individuals may have dietary restrictions or preferences based on their beliefs or traditions. The healthcare team should work with these individuals to develop a culturally sensitive approach to the diet, incorporating acceptable food choices and making modifications as needed[18].
By recognizing and addressing the unique needs of special populations, healthcare professionals can tailor the ketogenic diet to promote optimal seizure control, minimize side effects, and enhance quality of life for individuals with refractory epilepsy.
Emerging Research and Future Directions
As the understanding of the ketogenic diet’s mechanisms of action and potential applications continues to grow, researchers are exploring new avenues to optimize its effectiveness and expand its use in the treatment of epilepsy and other neurological disorders.
Identifying Biomarkers of Response
One area of active research is the identification of biomarkers that can predict an individual’s response to the ketogenic diet. By identifying specific genetic, metabolic, or neuroimaging markers associated with a favorable response, healthcare professionals could better target the diet to those most likely to benefit. This personalized approach could improve efficacy, minimize side effects, and enhance the overall success of the ketogenic diet in seizure control[19].
Optimizing Diet Composition and Delivery
Researchers are also investigating ways to optimize the composition and delivery of the ketogenic diet to improve its palatability, convenience, and long-term adherence. Some areas of focus include:
- Developing new ketogenic food products and meal replacement options
- Exploring the use of medium-chain triglyceride (MCT) supplements to reduce the diet’s restrictiveness
- Investigating the potential of exogenous ketone supplements to induce ketosis without strict dietary changes
By improving the diet’s accessibility and ease of use, more individuals with refractory epilepsy may be able to benefit from this therapeutic approach[20].
Combining the Ketogenic Diet with Other Therapies
Researchers are exploring the potential synergistic effects of combining the ketogenic diet with other epilepsy treatments, such as:
- Antiepileptic medications
- Vagus nerve stimulation
- Responsive neurostimulation
- Cannabidiol (CBD) or other cannabis-derived compounds
By leveraging the complementary mechanisms of action of these therapies, it may be possible to achieve greater seizure control and improve overall outcomes for individuals with refractory epilepsy.
Expanding the Use of the Ketogenic Diet to Other Neurological Disorders
Given the ketogenic diet’s neuroprotective and anti-inflammatory properties, researchers are investigating its potential therapeutic applications in other neurological disorders, such as:
- Alzheimer’s disease
- Parkinson’s disease
- Amyotrophic lateral sclerosis (ALS)
- Traumatic brain injury
- Migraine
While research in these areas is still in its early stages, preclinical studies and small clinical trials have shown promising results, warranting further investigation[21].
As research continues to unravel the complexities of the ketogenic diet and its effects on the brain, new insights and innovations may lead to more targeted, effective, and accessible treatments for epilepsy and other neurological disorders in the future.
Resources and Support for Ketogenic Diet Implementation
Implementing and maintaining a ketogenic diet for seizure control can be challenging, but numerous resources and support systems are available to help individuals and their families navigate this journey.
Healthcare Professional Guidance
The most crucial resource for those considering a ketogenic diet is a knowledgeable and experienced healthcare team. This team should include:
- A neurologist or epileptologist to oversee seizure management
- A registered dietitian with expertise in ketogenic diets to guide meal planning and nutritional monitoring
- Other specialists as needed, such as a pediatrician, gastroenterologist, or psychologist
These professionals will work together to develop a personalized ketogenic diet plan, monitor progress, and address any concerns or challenges that arise[22].
Educational Materials and Training
Various educational materials and training programs are available to help individuals and their caregivers understand and implement the ketogenic diet effectively. These resources may include:
- Books, brochures, and handouts explaining the diet’s principles and practical aspects
- Online courses or workshops covering meal planning, cooking techniques, and troubleshooting
- Instructional videos demonstrating ketogenic recipe preparation and portion control
Many healthcare institutions and epilepsy organizations offer these resources to support individuals embarking on a ketogenic diet journey.
Support Groups and Online Communities
Connecting with others who have experience with the ketogenic diet can provide invaluable support, encouragement, and practical advice. Support groups and online communities offer a platform for individuals and families to share their experiences, ask questions, and learn from one another. Some popular options include:
- Local or online support groups organized by healthcare institutions or epilepsy organizations
- Social media groups dedicated to the ketogenic diet for epilepsy
- Online forums and discussion boards hosted by reputable epilepsy or ketogenic diet websites
These communities can be a source of emotional support, motivation, and problem-solving strategies throughout the ketogenic diet journey[23].
Meal Planning and Recipe Resources
One of the most significant challenges of the ketogenic diet is creating a variety of appealing and nutritionally balanced meals that adhere to the diet’s strict macronutrient ratios. Fortunately, many resources are available to simplify meal planning and food preparation, such as:
- Ketogenic diet cookbooks and recipe websites
- Meal planning apps and software tailored to the ketogenic diet
- Pre-made ketogenic meals or meal delivery services
- Ketogenic diet calculators to help determine appropriate portion sizes and macronutrient ratios
These resources can help individuals maintain a diverse and enjoyable diet while staying within the prescribed ketogenic guidelines[24].
By leveraging the available resources and support systems, individuals with refractory epilepsy and their families can feel more confident and empowered as they navigate the challenges and reap the potential benefits of the ketogenic diet for seizure control.
Frequently Asked Questions
A ketogenic diet is a high-fat, low-carbohydrate diet that induces a metabolic state called ketosis. In ketosis, the body uses fat as its primary fuel source instead of carbohydrates. The ketogenic diet is often used as a treatment for refractory epilepsy, which is epilepsy that does not respond well to traditional medications.
The exact mechanisms by which the ketogenic diet helps control seizures are not fully understood. However, it is believed that the diet’s high fat content and the resulting production of ketones may have neuroprotective and anti-inflammatory effects on the brain. These effects may help stabilize neuronal activity and reduce the occurrence of seizures.
The ketogenic diet is primarily used for individuals with refractory epilepsy, particularly children and adolescents. It may also be considered for adults with refractory epilepsy who have not responded well to multiple antiepileptic medications. However, the diet’s effectiveness may vary from person to person, and it is essential to consult with a healthcare professional to determine if the ketogenic diet is an appropriate treatment option.
Some common side effects of the ketogenic diet include gastrointestinal issues (such as constipation, diarrhea, or nausea), low blood sugar, and micronutrient deficiencies. More serious side effects, such as kidney stones or liver problems, may occur in rare cases. Regular monitoring by a healthcare professional is essential to manage and prevent potential side effects.
The time it takes for the ketogenic diet to start controlling seizures varies from person to person. Some individuals may experience a reduction in seizures within a few days of starting the diet, while others may take several weeks or months to see significant improvements. It is essential to give the diet an adequate trial period, as determined by a healthcare professional, before assessing its effectiveness.
Yes, the ketogenic diet can be used in combination with other epilepsy treatments, such as antiepileptic medications or vagus nerve stimulation. In some cases, the diet may even allow for a reduction in the dosage or number of medications required. However, any changes to treatment plans should be made under the guidance of a healthcare professional.
There are many resources available to support individuals and families implementing a ketogenic diet for epilepsy. These include healthcare professional guidance, educational materials and training programs, support groups and online communities, and meal planning and recipe resources. Epilepsy organizations, healthcare institutions, and online forums can be valuable sources of information and support throughout the ketogenic diet journey.
Reference list
- Kossoff EH, Zupec-Kania BA, Auvin S, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;3(2):175-192.
- Martin-McGill KJ, Jackson CF, Bresnahan R, Levy RG, Cooper PN. Ketogenic diets for drug-resistant epilepsy. Cochrane Database Syst Rev. 2018;11(11):CD001903.
- Roehl K, Sewak SL. Practice Paper of the Academy of Nutrition and Dietetics: Classic and Modified Ketogenic Diets for Treatment of Epilepsy. J Acad Nutr Diet. 2017;117(8):1279-1292.
- Simeone TA, Simeone KA, Stafstrom CE, Rho JM. Do ketone bodies mediate the anti-seizure effects of the ketogenic diet? Neuropharmacology. 2018;133:233-241.
- Masino SA, Rho JM. Mechanisms of Ketogenic Diet Action. In: Masino SA, ed. Ketogenic Diet and Metabolic Therapies: Expanded Roles in Health and Disease. New York, NY: Oxford University Press; 2017:19-40.
- Boison D. New insights into the mechanisms of the ketogenic diet. Curr Opin Neurol. 2017;30(2):187-192.
- Augustin K, Khabbush A, Williams S, et al. Mechanisms of action for the medium-chain triglyceride ketogenic diet in neurological and metabolic disorders. Lancet Neurol. 2018;17(1):84-93.
- Puchalska P, Crawford PA. Multi-dimensional Roles of Ketone Bodies in Fuel Metabolism, Signaling, and Therapeutics. Cell Metab. 2017;25(2):262-284.
- Youm YH, Nguyen KY, Grant RW, et al. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nat Med. 2015;21(3):263-269.
- Gano LB, Patel M, Rho JM. Ketogenic diets, mitochondria, and neurological diseases. J Lipid Res. 2014;55(11):2211-2228.
- Rogawski MA, Löscher W, Rho JM. Mechanisms of Action of Antiseizure Drugs and the Ketogenic Diet. Cold Spring Harb Perspect Med. 2016;6(5):a022780.
- Youngson NA, Morris MJ, Ballard JWO. The mechanisms mediating the antiepileptic effects of the ketogenic diet, and potential opportunities for improvement with metabolism-altering drugs. Seizure. 2017;52:15-23.
- Kossoff EH, Cervenka MC, Henry BJ, Haney CA, Turner Z. A decade of the modified Atkins diet (2003-2013): Results, insights, and future directions. Epilepsy Behav. 2013;29(3):437-442.
- Payne NE, Cross JH, Sander JW, Sisodiya SM. The ketogenic and related diets in adolescents and adults—A review. Epilepsia. 2011;52(11):1941-1948.
- McDonald TJW, Cervenka MC. The Expanding Role of Ketogenic Diets in Adult Neurological Disorders. Brain Sci. 2018;8(8):148.
- Kverneland M, Selmer KK, Nakken KO, Iversen PO, Taubøll E. A prospective study of the modified Atkins diet for adults with idiopathic generalized epilepsy. Epilepsy Behav. 2015;53:197-201.
- Cervenka MC, Kossoff EH. Dietary treatment of intractable epilepsy. Continuum (Minneap Minn). 2013;19(3 Epilepsy):756-766.
- Ye F, Li XJ, Jiang WL, Sun HB, Liu J. Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis. J Clin Neurol. 2015;11(1):26-31.
- Ladino LD, Hernández-Ronquillo L, Téllez-Zenteno JF. The ketogenic diet and its variants as treatments for epilepsy in adults: A review. Epilepsy Res. 2020;168:106519.
- Li RJ, Liu Y, Liu HQ, Li J. Ketogenic diets and protective mechanisms in epilepsy, metabolic disorders, cancer, neuronal loss, and muscle and nerve degeneration. J Food Biochem. 2020;44(3):e13140.
- Sampaio LP. Ketogenic diet for epilepsy treatment. Arq Neuropsiquiatr. 2016;74(10):842-848.
- Williams TJ, Cervenka MC. The role for ketogenic diets in epilepsy and status epilepticus in adults. Clin Neurophysiol Pract. 2017;2:154-160.
- Schoeler NE, Cross JH. Ketogenic dietary therapies in adults with epilepsy: a practical guide. Pract Neurol. 2016;16(3):208-214.
- Patel A, Pyzik PL, Turner Z, Rubenstein JE, Kossoff EH. Long-term outcomes of children treated with the ketogenic diet in the past. Epilepsia. 2010;51(7):1277-1282.
