The ketogenic diet is a high fat, low carbohydrate diet that has become a health fad but it was originally posited as a benefit for people with epilepsy.

A review of 10 years of data at Ann&Robert H. Lurie Children's Hospital of Chicago confirms that it doesn't help - with infants and kids under age 3 who have epilepsy due to a confirmed genetic abnormality. Generally, it is only in the last few years that epilepsy specialists began offering ketogenic diet to younger kids, and most studies in infants have only included babies with infantile spasms. The current report describes experience using the ketogenic diet with an expanded population of young patients who had various types of epilepsy that began in infancy. In their review, the youngest patient to start ketogenic diet was only 3 weeks old. 

It's still only 109 children and from one organization but close to 20 percent achieved complete seizure control after three months on ketogenic diet and nearly 40 percent had significant seizure reduction (more than 50 percent). In children with genetic causes of epilepsy, outcomes were even more favorable, with nearly half experiencing more than 50 percent seizure reduction. The age of seizure onset or age at the ketogenic diet initiation were not related to the eventual seizure outcome.

Eighteen-month-old Catherine Adams was treated with ketogneic diet and is now seizure free.
Image credit: Lurie Children's Hospital

Only about 10 percent of the children included in the study withdrew early. Among these, there were no critical adverse events related to the ketogenic diet.

"The ketogenic diet is challenging to maintain and parents need extensive multidisciplinary support, especially during the complicated period of solid food introduction," says study author John Millichap, MD, an epilepsy specialist at Lurie Children's and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine. ""Overall, we observed that ketogenic diet continues to be a safe, effective and well-tolerated treatment for patients under 3 years of age with drug-resistant epilepsy."

Diets have long been used for epilepsy. A starvation diet was promoted in 1911 but dietary changes had been tried since 500 B.C. The ketogenic diet was used beginning in the 1920s but declined in popularity as medicine became more successful. With its renewed popularity as a diet fad that has made it possible to take a new look at which forms of epilepsy might actually be helped. Cultural prominence means greater likelihood of research funding.

"Large, multicenter studies are needed for us to establish which genetic epilepsy syndromes respond best to the ketogenic diet so that we can add it to our precision medicine toolkit," noted Millichap.