Pediatric Ketogenic Diet for Seizures

There's evidence that a special diet, called the ketogenic (or keto) diet, can help children with epilepsy. If medications don't control your child's epilepsy or cause troublesome side effects, the ketogenic diet for seizures may be an option.

You've probably heard of the keto diet, which gained popularity as a fad diet for weight loss a few decades ago. But this diet has been around for much longer – in fact, it's been used for seizure control for a century. Researchers still aren't quite sure why it can be effective, yet it's been shown to work.

You may also hear this treatment referred to as the epilepsy diet or dietary therapy for seizures.

What is the ketogenic diet for seizures?

The ketogenic diet is a high-fat, moderate-protein, low-carbohydrate diet. It maintains a strict ratio of fat to carbohydrate and protein, with about 90% of calories coming from fat.

Russell Wilder, a doctor and medical researcher with the Mayo Clinic, developed the diet in the 1920s. It was widely used to treat epilepsy until the 1950s, when effective anti-seizure medications became available.

Today, the ketogenic diet is regaining popularity as a treatment option when epilepsy isn't controlled by medications. Studies have consistently shown that the diet can help to reduce seizures in 50 to 75% of children with difficult-to-treat epilepsy.

Who may benefit from the ketogenic diet for seizures

While the ketogenic diet doesn't work for everyone, it can reduce seizures in many children with epilepsy.

The diet can work for all types of seizures and epilepsy syndromes. It's often helpful for the following:

• Infantile spasms
• Doose syndrome (myoclonic-astatic epilepsy)
• Dravet syndrome
• GLUT1 deficiency syndrome
• Neuronal migration disorders
• Rett syndrome
• Tuberous sclerosis complex

If your child is diagnosed with epilepsy, their doctor will first try prescribing a medication to control the seizures. If two anti-seizure medications fail to do this, the doctor may recommend dietary therapy.

Many children on the ketogenic diet also take anti-seizure medications, but on average they need fewer medications and lower dosages.

Alternatives to the ketogenic diet for seizures

In addition to the classic ketogenic diet, other versions are now available, including modified ketogenic diets, the modified Atkins diet and the low glycemic index diet. These versions allow for more flexibility in preparation or in the amounts of protein and carbohydrates allowed.

Ketogenic dietary therapy at UCSF Health

To try this option for your child, you'll have an initial consultation with a nurse practitioner and a dietitian who specializes in ketogenic dietary therapies. During this appointment, the team will:

• Provide an overview of different ketogenic dietary therapies available as well as side effects and treatment expectations
• Review your child's medical history and order baseline lab tests to ensure dietary treatment is appropriate
• Discuss your child's current diet and growth
• Determine which dietary treatment is likely the best option for your child

Because this treatment requires medical supervision, the team will monitor your child closely after they start the diet. The team may adjust your child's plan as needed to help your child tolerate the diet and to optimize results.

We recommend children stay on the ketogenic diet for 90 days to determine whether it can help control their seizures.