Skip to main content Accessibility help
Hostname: page-component-56f9d74cfd-rbfsf Total loading time: 0.493 Render date: 2022-06-27T00:43:40.288Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true }

The ketogenic diet in children with epilepsy

Published online by Cambridge University Press:  08 March 2007

D. Papandreou*
2nd Pediatric Clinic, Medical School of Aristotelion University of Thessaloniki, Greece
E. Pavlou
2 Neurology Department, 2nd Pediatric Clinic, Medical School of Aristotelion University of Thessaloniki, Greece
E. Kalimeri
Nutrition Department, General Hospital of Kozani, Greece
I. Mavromichalis
2nd Pediatric Clinic, Medical School of Aristotelion University of Thessaloniki, Greece
*Corresponding author: Dr D. Papandreou, fax +302310-230000, email
Rights & Permissions[Opens in a new window]


HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Children with epilepsy, especially those facing intractable seizures, experience a great impact on the quality of their lives. Effective treatment is essential, and although new anti-epileptic drugs have shown an improved profile of action, still a substantial number of children look for more efficacious ways of treatment that are far away from potential toxicity and ineffectiveness. The ketogenic diet is a dietary therapy for epileptic children based on manipulation of metabolism principles and brain energetics. This regimen aims to produce a controlled ketonaemia through excessive dietary fat intake, little carbohydrates and adequate (for growth) protein. The present paper is a review of previous and current papers regarding the proposed mechanisms of the ketogenic diet’s action, and the efficacy of the regimen on epileptic children. Unfortunately, a few small studies in sample size and duration tried to evaluate the potential risks of this regimen and their results were rather inconclusive. Further research needs to be done in order for the exact mechanism of the ketogenic diet to be clarified which will help to improve the diet’s application, especially for vulnerable epileptic children as far as their growth is concerned.

Review article
Copyright © The Nutrition Society 2006


Al-Mudallal, AS, LaManna, JC, Lust, WD & Harik, SLDiet-induced ketosis does not cause cerebral acidosis. Epilepsia (1996) 37 258261CrossRefGoogle Scholar
Anonymous 1981 Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia (1981) 22 489501CrossRefGoogle Scholar
Bergqvist, AG, Chee, CM, Lutchka, L & Stallings, VASeleniumcdeficiency associated with cardiomyopathy: a complication of the ketogenic diet Epilepsia (2003) 44 618620CrossRefGoogle ScholarPubMed
Berry–Kravis, E, Booth, G, Sanchez, AC & Woodbury-Kolb, JCarnitine levels and the ketogenic diet. Epilepsia (2001) 42 14451451CrossRefGoogle ScholarPubMed
Berryman, MSThe ketogenic diet revised J Am Diet Assoc (1997) 97 Suppl. 2 192194CrossRefGoogle Scholar
Bough, KJ & Eagles, DAA ketogenic diet increases the resistance to pentylenetetrazole-induced seizures in rats. Epilepsia (1999) 40 138143CrossRefGoogle Scholar
Bruehl, C, Hagemann, G & Witte, OWUncoupling of blood flow and metabolism in epilepsy. Epilepsia (1998) 39 12351239CrossRefGoogle ScholarPubMed
Carroll, J & Koenigsberger, DThe ketogenic diet: a practical guide for caregivers. J Am Diet Assoc (1998) 98 316321CrossRefGoogle ScholarPubMed
Coppola, G, Veggiotti, P, Cusmai, R et al. The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience. Epilepsy Res (2002) 48 221227CrossRefGoogle Scholar
Cornford, EM, Shamsa, K, Zeitzer, JM, Enriquez, CM, Wilson, CL, Behnke, EJ, Fried, I & Engel, JRegional analyses of CNS microdialysate glucose and lactate in seizure patients. Epilepsia (2002) 43 13601371CrossRefGoogle ScholarPubMed
Couch, SC, Schwarzman, F, Carroll, J, Koenigsberger, D, Nordli, DR, Deckelbaum, RJ & DeFelice, ARGrowth and nutritional outcomes of children treated with the ketogenic diet. J Am Diet Assoc (1999) 99 15731575CrossRefGoogle ScholarPubMed
Cunnane, SC, Musa, K, Ryan, MA, Whiting, S & Fraser, DDPotential role of polyunsaturates in seizure protection achieved with the ketogenic diet. Prostaglandins Leukot Essent Fatty Acids (2002) 67, 131135CrossRefGoogle ScholarPubMed
DiMario, FJ & Holland, JThe ketogenic diet: a review of the experience at Connecticut Children's Medical Center Pediatr Neurol (2002) 26 288292CrossRefGoogle ScholarPubMed
Edelstein, SF & Chisholm, MManagement of intractable childhood seizures using the non-MCT oil ketogenic diet in 20 patients. J Am Diet Assoc (1996) 96 11811182CrossRefGoogle ScholarPubMed
El–Mallakh, RS & Paskitti, METhe ketogenic diet may have mood-stabilizing properties. Med Hypotheses (2001) 57 724726CrossRefGoogle ScholarPubMed
Flavin, HJ, Wieraszko, A & Seyfried, TNEnhanced aspartate release from hippocampal slices of epileptic (EL) mice. J Neurochem (1991) 56 10011007CrossRefGoogle ScholarPubMed
Fraser, DD, Hoehn, K, Weiss, S & MacVicar, BAArachidoniccacid inhibits sodium currents and synaptic transmission in cultured striatal neurons. Neuron (1993) 11 633644CrossRefGoogle ScholarPubMed
Fraser, DD, Whiting, S, Andrew, RD, Macdonald, EAMusa-Veloso, K & Cunnane SC Elevated polyunsaturated fatty acids in blood serum obtained from children on the ketogenic diet. Neurology (2003) 60 10261029CrossRefGoogle ScholarPubMed
Freeman, JMWhat every paediatrician should know about the ketogenic diet. Contemp Pediatr (2003) 20 113127Google Scholar
Freeman, JM, Vining, EPG, Pillas, DJ, Pyzik, PL, Casey, J & Kelly, M, The efficacy of the ketogenic diet-1998, a prospective evaluation of intervention in 150 children. Pediatrics (1998) 102 13581363CrossRefGoogle ScholarPubMed
Greene, AE, Todorova, MT, McGowan, R & Seyfried, TNCaloric restriction inhibits seizure susceptibility in epileptic mice by reducing blood glucose. Epilepsia (2000) 42, 13711378.CrossRefGoogle Scholar
Hamill, P, Drizd, T, Johnson, C, Reed, R & Roche, A, NCHS growth curves for children birth—18 years. United States, Vital Health Stat 11 (1997) 165 174.Google Scholar
Hassan, AM, Keene, DL, Whiting, SE, Jacob, PJ, Champagne, JR & Humphreys, PKetogenic diet in the treatment of refractory epilepsy in childhood. Pediatr Neurol (1999) 21, 548552CrossRefGoogle ScholarPubMed
Haymond, MW, Howard, C, Ben-Galim, E & de Vivo, DC, Effects of ketosis on glucose flux in children and adults. Am J Physiol, (1983) 245, E373E378.Google ScholarPubMed
Hemingway, C, Freeman, JM, Pillas, DJ & Pryzik, PLThecketogenic diet: a 3-to-6-year follow-up of 150 children enrolled prospectively. Pediatrics (2001) 108, 898905.CrossRefGoogle ScholarPubMed
Holmes, GL & Ben–Ari, YThe neurobiology and consequences of epilepsy in the developing brain. Pediatr Res (2001) 49, 320325.CrossRefGoogle ScholarPubMed
Hossain, SA, La Vega-Talbott, M & Solomon, GEKetogenic diet in pediatric epilepsy patients with gastrostomy feeding. Pediatr Neurol (2005) 32 8183.CrossRefGoogle Scholar
Jirapinyo, P, Kankirawatana, P, Densupsoontorn, N, Thamonsiri, N & Wongarn, RHigh plasma branched-chain amino acids:aromatic amino acids ratio in children on the ketogenic diet: a mechanism in controlling epilepsy. J Med Assoc Thai (2004) 87, 432437.Google ScholarPubMed
Kang, CH, Kim, J, Kim, WK & Kim, DHEfficacy and safety of the ketogenic diet for intractable childhood epilepsy: Korean multicenter experience. Epilepsia (2005) 46, 272279.CrossRefGoogle Scholar
Kinsman, SL, Vining, EP, Quaskey, SA, Mellits, D & Freeman, JMEfficacy of the ketogenic diet for intractable seizure disorders: review of 58 cases. Epilepsia (1992) 33, 11321136.CrossRefGoogle ScholarPubMed
Kwiterovich, PO, Vining, EPG, Pyzik, P, Skolasky, R & Freeman, JMEffect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins and apolipoproteins in children. JAMA (2003) 290, 912920CrossRefGoogle ScholarPubMed
Lefevre, F & Aronson, NKetogenic diet for the treatment of refractory epilepsy in children A systematic review of efficacy. Pediatrics (2000) 105 E46.CrossRefGoogle Scholar
Leino, RL, Gerhart, DZ, Duelli, R, Enerson, BE & Drewes, LRDiet-induced ketosis increases monocaboxylate transporter (MCT1) levels in rat brain. Neurochem Int (2001) 38 519527.CrossRefGoogle Scholar
Lightstone, L, Shinnar, S, Callahan, CM, O'Dell, C, Moshe, SL, Ballaban-Gil, KRReasons for failure of the ketogenic diet. J Neurosc Nurs (2001) 33, 292295.CrossRefGoogle ScholarPubMed
Likhodii, SS & Burnham, WMKetogenic diet: does acetone stop seizures?" Med Sci Monit (2002) 8, HY19HY24.Google Scholar
Likhodii, SS, Musa, K & Cunnane, SCBreath acetone as a measure of systemic ketosis assessed in rat model of the ketogenic diet. Clin Chem (2002) 48, 115120Google ScholarPubMed
Lipton, SA & Rosenberg, PAExcitatory amino acids as a final common pathway for neurologic disorders. N Engl J Med (1994) 330, 613622.Google ScholarPubMed
Liu, Y-MC, Williams, S, Basualdo-Hammond, C, Stephens, D & Curtis, RA prospective study: growth and nutritional status of children treated with the KD. J Am Diet Assoc (2003) 103, 707712.CrossRefGoogle Scholar
MacCracken, KA & Scalisi, JCDevelopment and evaluation of a ketogenic diet program. J Am Diet Assoc (1999) 99, 15541558.CrossRefGoogle ScholarPubMed
McEwan, MJ, Espie, CA & Metcalfe, JA systematic review of the contribution of qualitative research to the study of quality of life in children and adolescents with epilepsy. Seizure (2004) 13, 314.CrossRefGoogle Scholar
McGhee, B & Neelam, KAvoid unnecessary drug-related carbohydrates for patients consuming the ketogenic diet. J Am Diet Assoc (2001) 101, 87101.CrossRefGoogle ScholarPubMed
Marson, AG & Chadwick, DWNew drug treatments for epilepsy. J Neurol Neurosurg Psychiatry (2001) 70, 143148.CrossRefGoogle ScholarPubMed
Marson, AG, Kadir, ZA, Hutton, JL et al. , The new antiepileptic drugs: a systematic review of their efficacy and tolerability. Epilepsia (1997) 38, 859880.CrossRefGoogle ScholarPubMed
Maydell, BV, Wyllie, E, Akhtar, N, Kotagal, P, Powaski, K, Cook, K, Weinstock, A & Rothner, ADEfficacy of the ketogenic diet in focal versus generalized seizures. Pediatr Neurol (2001) 25, 208212.CrossRefGoogle ScholarPubMed
Musa-Veloso, K, Rarama, E, Comeau, F, Curtis, R & Cunnane, SCEpilepsy and the ketogenic diet: assessment of ketosis in children using breath acetone. Pediatr Res (2002) 52, 443448.CrossRefGoogle ScholarPubMed
Nehlig, A & Pereira de Vasconcelos, AGlucose and ketone body utilization by the brain of neonatal rats. Prog Neurobiol (1993) 40, 163221.CrossRefGoogle ScholarPubMed
Novotny, EJ Jr, Chen, J & Rothman, DLAlterations in cerebral metabolism with the ketogenic diet. Epilepsia (1997) 38, 147.Google Scholar
Peterman, MGThe ketogenic diet in epilepsy JAMA (1925) 84, 19791983.CrossRefGoogle Scholar
Prasad, AN & Stafstrom, CEDietary therapy of epilepsy in the nineties; renewed experience with the ketogenic diet. Nutr Res, (1998) 18 403416.CrossRefGoogle Scholar
Pulsifer, MB, Gordon, JM, Vining, EPG & Freeman, JMEffects of ketogenic diet on development and behaviour: preliminary report of a prospective study. Dev Med Child Neurol (2001) 43, 301306.CrossRefGoogle ScholarPubMed
Schwartz, RM, Boyes, S & Aynsley-Green, AMetabolic effects of three ketogenic diets in the treatment of severe epilepsy. Dev Med Child Neurol (1989a) 31, 152.CrossRefGoogle ScholarPubMed
Schwartz, RM, Eaton, J, Bower, BD & Aynsley-Green, AKetogenic diet in the treatment of epilepsy: short-term clinical effects. Dev Med Child Neurol (1989b) 31, 145151.CrossRefGoogle ScholarPubMed
Sheth, RD & Stafstrom, CEIntractable pediatric epilepsy: vagal nerve stimulation and the ketogenic diet. Neurol Clin North Am (2002) 20 11831194.CrossRefGoogle ScholarPubMed
Shorvon, S & Stephan, HOverview of the safety of newer antiepileptic drugs. Epilepsia (1997) 38, S45S51.CrossRefGoogle ScholarPubMed
Stafstrom, CEAnimal models of the ketogenic diet: what have we learned, what can we learn?" Epilepsy Res (1999) 37, 241259.CrossRefGoogle Scholar
Stanley, CACarnitine disorders Adv Pediatr (1995) 42, 209242.Google ScholarPubMed
Thavendiranathan, P, Mendonca, A, Dell, C, Likhodii, SS, Musa, K, Iracleous, C, Cunnane, SC &Burnham, WMThe MCT ketogenic diet: effects on animal seizure models. Exp Neurol (2000) 161, 696703.CrossRefGoogle ScholarPubMed
Thiel, RJ & Fowkes, SWDown syndrome and epilepsy: a nutritional connection?" Med Hypotheses (2004) 62, 3544.CrossRefGoogle Scholar
Thio, LL, Wong, M & Yamada, KAKetone bodies do not directly alter excitatory or inhibitory hippocampal synaptic transmission. Neurology (2000) 54, 325Abstr.CrossRefGoogle ScholarPubMed
VanItallie, TB & Nufert, THKetones: metabolism's ugly duckling. Nutr Rev (2000) 61, 327341.CrossRefGoogle Scholar
Vining, EPGClinical efficacy of the ketogenic diet. Epilepsy Res (1999) 37, 181190.CrossRefGoogle ScholarPubMed
Vining, EPG, Freeman, JM, Ballaban-Gill, K et al. A multicenter study of the efficacy of the ketogenic diet. Arch Neurol (1998) 55, 14331437.CrossRefGoogle ScholarPubMed
Vining, EPG, Pyzik, P, McGrogan, J, Hladky, H, Anand, A, Kriegler, S & Freeman, JMGrowth of children on the ketogenic diet. Dev Med Child Neurol (2002) 44, 796802.CrossRefGoogle ScholarPubMed
Wallas, CJ, Farrell, K (eds) Epilepsy in Children 405408LondonArnold (2004).Google Scholar
Wheless, JW, Baumgartner, J & Ghanbari, CVagus nerve stimulation and the ketogenic diet. Neurol Clin (2001) 19, 371407.CrossRefGoogle ScholarPubMed
Wilder, RMThe effect of ketonemia on the course of epilepsy. Mayo Clin Bull (1921) 2, 307.Google Scholar
Williams, S, Basualdo-Hammond, C, Curtis, R & Schuller, RGrowth retardation in children with epilepsy on the ketogenic diet: a retrospective chart review. J Am Diet Assoc (2002) 102, 405407.CrossRefGoogle ScholarPubMed
Yehuda, A, Carasso, RL & Mostovsky, DIEssential fatty acid preparation (SR-3) raises the seizure threshold in rats. Eur J Pharmacol (1994) 254, 193198.CrossRefGoogle ScholarPubMed
Yudkoff, M, Daikhin, Y, Nissim, I, Lazarow, A & Nissim, IBrain amino acid metabolism and ketosis. J Neurosci Res (2001) 66, 272281.CrossRefGoogle ScholarPubMed
Ziegler, DR, Araujo, E, Rotta, LN, Perry, ML & Goncalves, C-AA ketogenic diet increases protein phosphorylation in brain slices of rats. J Nutr (2002) 132, 483487.CrossRefGoogle ScholarPubMed
You have Access
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The ketogenic diet in children with epilepsy
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

The ketogenic diet in children with epilepsy
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

The ketogenic diet in children with epilepsy
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *