Ketogenic diets:  new advances for metabolism-based therapies.
OBJECTIVE
Despite myriad anticonvulsants available and in various stages of development, there are thousands of children and adults with epilepsy worldwide still refractory to treatment and not candidates for epilepsy surgery. Many of these patients will now turn to dietary therapies such as the ketogenic diet, medium-chain triglyceride diet, modified Atkins diet, and low glycemic index treatment.


RESULTS
In the past several years, neurologists are finding new indications to use these dietary treatments, perhaps even as first-line therapy, including infantile spasms, myoclonic-astatic epilepsy (Doose syndrome), Dravet syndrome, and status epilepticus (including FIRES syndrome). Adults are also one of the most rapidly growing populations being treated nowadays; this group of patients previously was not typically offered these treatments. In 2009, two controlled trials of the ketogenic diet were published, as well as an International Expert Consensus Statement on dietary treatment of epilepsy. Ketogenic diets are also now being increasingly studied for neurological conditions other than epilepsy, including Alzheimer's disease and cancer. Insights from basic science research have helped elucidate the mechanisms by which metabolism-based therapy may be helpful, in terms of both an anticonvulsant and possibly a neuroprotective effect.


CONCLUSIONS
Dietary therapy for epilepsy continues to grow in popularity worldwide, with expanding use for adults and conditions other than epilepsy.
Departments of Neurology and Pediatrics, The John M. Freeman Pediatric Epilepsy Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. ekossoff@jhmi.edu
Eric H
EH
Kossoff
Adam L
AL
Hartman
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D055423:Diet, Ketogenic / Q000009:adverse effects / Q000379:methods*; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007662:Ketosis / Q000139:chemically induced; D008659:Metabolic Diseases / Q000139:chemically induced*
D000927:Anticonvulsants