title: Ketogenic diet guidelines for infants with refractory epilepsy.
abstract: BACKGROUND
  The ketogenic diet (KD) is an established, effective non-pharmacologic treatment for drug resistant childhood epilepsy. For a long time, the KD was not recommended for use in infancy (under the age of 2 years) because this is such a crucial period in development and the perceived high risk of nutritional inadequacies. Indeed, infants are a vulnerable population with specific nutritional requirements. But current research shows that the KD is highly effective and well tolerated in infants with epilepsy. Seizure freedom is often achieved and maintained in this specific patient group. There is a need for standardised protocols and management recommendations for clinical use.
  
  
  METHODS
  In April 2015, a project group of 5 experts was established in order to create a consensus statement regarding the clinical management of the KD in infants. The manuscript was reviewed and amended by a larger group of 10 international experts in the KD field. Consensus was reached with regard to guidance on how the diet should be administered and in whom.
  
  
  RESULTS
  The resulting recommendations include patient selection, pre-KD counseling and evaluation, specific nutritional requirements, preferred initiation, monitoring of adverse effects at initiation and follow-up, evaluation and KD discontinuation.
  
  
  CONCLUSIONS
  This paper highlights recommendations based on best evidence, combined with expert opinions and gives directions for future research.
authors.affiliation: Erasmus Medical Center Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. Electronic address: e.vanderlouw@erasmusmc.nl.
authors.forename: Elles
authors.initials: E
authors.lastname: van der Louw
authors.affiliation: Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands. Electronic address: t.vandenhurk@umcutrecht.nl.
authors.forename: Dorine
authors.initials: D
authors.lastname: van den Hurk
authors.affiliation: Matthews Friends Clinics, Lingfield, UK. Electronic address: e.neal@mfclinics.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Neal
authors.affiliation: University of Essen, Children's Hospital, Germany. Electronic address: baerbel.Leiendecker@uk-essen.de.
authors.forename: Bärbel
authors.initials: B
authors.lastname: Leiendecker
authors.affiliation: Great Ormond Street Hospital for Children, London, UK. Electronic address: Georgiana.Fitzsimmons@gosh.nhs.uk.
authors.forename: Georgiana
authors.initials: G
authors.lastname: Fitzsimmon
authors.affiliation: Medical University of South Carolina, USA. Electronic address: kenla@musc.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Dority
authors.affiliation: Children's Mercy Hospital and Clinics, Overland Park, KS, USA. Electronic address: lmthompson@cmh.edu.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Thompson
authors.affiliation: University of Modena and Reggio Emilia, Italy. Electronic address: maddalena.marchio@unimore.it.
authors.forename: Maddelena
authors.initials: M
authors.lastname: Marchió
authors.affiliation: Center of Pediatrics and Oncology, Chorzow, Poland. Electronic address: mdudzinskapl@yahoo.com.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Dudzińska
authors.affiliation: Medical University Vienna, Austria. Electronic address: anastasia.dressler@meduniwien.ac.at.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dressler
authors.affiliation: Klinikum Aschaffenburg-Alzenau, Germany. Electronic address: Jorg.Klepper@klinikum-ab-alz.de.
authors.forename: Joerg
authors.initials: J
authors.lastname: Klepper
authors.affiliation: Pediatric Epilepsy & Child Neurology Paris-Diderot University, France. Electronic address: stephane.auvin@aphp.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Auvin
authors.affiliation: UCL Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, London, UK. Electronic address: h.cross@ucl.ac.uk.
authors.forename: J Helen
authors.initials: JH
authors.lastname: Cross
mesh_terms: D055423:Diet, Ketogenic / Q000379:methods*; D019468:Disease Management; D004827:Epilepsy / Q000178:diet therapy*; D006801:Humans; D007223:Infant; D016896:Treatment Outcome
keywords: Guidelines; Infant; Ketogenic diet; Refractory epilepsy