ABSTRACT
Introduction and History of Dietary Management of Epilepsy ..................................................... 530 Implementation of Dietary Therapy ............................................................................................... 530 Physiology and Mechanism of Action of the Ketogenic Diet ........................................................ 531
Indications for Dietary Treatment of Epilepsy .......................................................................... 531 Initiating the Diet ........................................................................................................................... 532
Pre-Diet ..................................................................................................................................... 532 Diary ..................................................................................................................................... 532 Contraindications ................................................................................................................. 532 Screening Labs ..................................................................................................................... 532 Psychosocial Evaluation ....................................................................................................... 533
Diet Choice................................................................................................................................ 533 Clinical Case Examples-Which Diet to Choose? .............................................................. 534
Initiation .................................................................................................................................... 534 Ketogenic Diet ...................................................................................................................... 535 Medium-Chain Triglycerides ............................................................................................... 535 MAD and LGIT .................................................................................................................... 535
Dietary Specics of the Ketogenic Diet ......................................................................................... 535 Calculating the Diet for a Sample Patient ................................................................................. 536 Dietary Supplements ................................................................................................................. 538 Special Considerations for All-Liquid Diets ............................................................................. 538
Alternative Diets (MCT, MAD, LGIT) .......................................................................................... 538 Medium-Chain Triglycerides .................................................................................................... 538 Modied Atkins Diet ................................................................................................................. 539 Low Glycemic Index Treatment ................................................................................................540 General Note on Alternative Diets ............................................................................................ 541
Side Effects of the Ketogenic Diet and Its Alternatives ................................................................. 542 Ketogenic Diet Side Effects ...................................................................................................... 542 Alternative Diets (MCT, MAD, LGIT) Side Effects ................................................................. 543
Psychosocial Issues and Effects ..................................................................................................... 543 Sample Food Ideas for Carbohydrate Alternatives ........................................................................ 543
Baked Goods ............................................................................................................................. 543 Pasta, Bread, Rice, and Crackers............................................................................................... 545 Fried Food ................................................................................................................................. 545
Dietary Therapy for Epilepsy in Adults ......................................................................................... 545 Conclusion .....................................................................................................................................546 Sources for More Information Including Recipes and Support Groups ........................................546 References ......................................................................................................................................546
Epilepsy is dened as “any group of syndromes characterized by paroxysmal transient disturbances of brain function that may be manifested as episodic impairment or loss of consciousness, abnormal motor phenomena, psychic or sensory disturbances, or perturbation of the autonomic nervous system due to electrical activity disturbances in the brain.”1 There are about 40 different types of epileptic syndromes and about 200 different types of seizures. Epilepsy as a disease has existed since ancient times, with the Greeks having some of the earliest reports of “the falling sickness.” Dietary treatment for epilepsy has also been considered a prominent therapy since the earliest mentions of epilepsy. Many “treatments” were considered for epilepsy, which included a decrease or increase in consumption of certain foods. Hippocrates was one of the rst to report fasting as a method to stop a seizure. Aristotle believed that food formed an evaporated material in the veins that would rise upward, turn around, and descend. He believed that if too much evaporated material is carried up into the veins, the veins will swell and compress the respiratory center causing convulsions.2
