What's involved on the Ketogenic Diet?
If your child has failed on several (up to four) anti-epileptic drugs (i.e. their seizures remain uncontrolled), your child’s treating Neurologist may consider placing them on the Ketogenic Diet as an additional treatment to their AED’s. Children normally remain on their anticonvulsants while the diet is initiated. If the diet is successful, your child may have their anticonvulsants gradually reduced under medical supervision as decided by your neurologist / paediatrician.
The procedure for commencing on the Ketogenic Diet may vary slightly across settings. However, initiation typically follows the following process:
Initial consultation and planning
- Your child’s full medical history will be reviewed and a dietary history will be obtained.
- Your child will be screened for conditions which may contraindicate commencing on the diet (for example, children who have errors of fat metabolism cannot be placed on the diet).
- The exact dietary requirements will be determined by the Paediatric Dietician. This will involve calculations of calorie requirements, fluid intake, and the appropriate ketogenic ratio of fat to carbohydrate and protein.
- Parents and carers will receive education about the diet and the side-effects to look out for, and will receive ongoing support from the treating team.
- Prior to commencement on the diet, a sample of your child’s blood and urine will be collected and analysed.
- A baseline 12-lead ECG (heart monitoring) and a baseline EEG (monitoring of the electrical activity of the brain) will also be conducted.
Commencement on the diet
- The Classical Ketogenic Diet is initiated by admission to hospital and generally involves a 4-5 day stay. There are other diets, such as the Modified Atkins Diet which can be initiated in the outpatient setting. It is very important that all diets are initiated under medical supervision.
- Your child’s blood glucose level will be checked frequently (i.e. generally every 4 hours via finger prick test for the Classical Ketogenic Diet, or once daily during initiation on the Modified Atkins Diet), to monitor for hypoglycaemia.
- Further blood tests are usually required on day 3.
- Your child may feel lethargic and lack energy for some time while they adjust to the diet.
Maintenance of the Diet
- Your child will continue to be monitored regularly on the diet by attending an outpatient clinic (i.e. typically every 3 months in older children, more frequently in infants).
- Parents are encouraged to persist with the diet for at least 3 months to determine if seizure freedom or reduction occurs.
- Typically, children come off the Ketogenic Diet after around two years. The treating Neurologist will determine when the diet will be discontinued and the method for gradual discontinuation.
Efficacy of Ketogenic Diet
Research suggests that the Ketogenic Diet:
- reduces seizure frequency by more than 50% in half of all patients who try it,
- reduces seizure frequency by more than 90% in one third of patients.
- provides seizure freedom in some patients (6-10%).
 Kossof et al. (2009). Ketogenic Diets: an update for child neurologists. J Child Neurol 24(8): 979-988.
 Henderson et al. (2006). Efficacy of the Ketogenic Diet as a treatment option for epilepsy: meta-analysis. J child Neurol 21:193-198.
The information provided on this page was created on the 10th October 2014. It has been written by members of the PENNSW Website Editorial Committee in consultation with:
- Dr Michael Cardamone, Paediatric Neurologist, Sydney Children's Hospital Randwick (PhD, University of Melbourne; MBBS University of Sydney, FRACP)
Helen Kepreotes, Paediatric Dietitian, Sydney Children's Hospital Randwick (BSc Master Nutrition & Dietetics, APD)