Some seizures in children have no known cause. If these unprovoked seizures recur, it may be called epilepsy. Seizures can be stressful for the child and family. Medication can be an effective treatment for some, but others may need more help to control their seizures.
A special diet called the Ketogenic Diet may help manage epilepsy in children, particularly with epilepsy that is resistant to medication. The diet requires lower amounts of carbohydrates and high amounts of fat. It can be a difficult diet to maintain, but for some children the seizure control may be worth the effort. Most doctors will have a person try the diet for up to 3 months to see if it works. If your child responds well to the diet and remains seizure-free for 2 years, your child may also slowly be transitioned to a more normal diet.
Treatment of epilepsy was generally ineffective in the early 1900's. In the 1920s, it was found that fasting could reduce the number of seizures, but it was not clear why. Fortunately, anti-seizure medications were developed that helped the majority of people with epilepsy. As a result, dietary treatments lost popularity as a main treatment option for epilepsy.
The ketogenic diet is a high fat, low carbohydrate diet. The classic diet is made up of 3 to 4 parts fat and 1 part carbohydrate and protein. There are variations of the diet, like one that uses medium chain triglycerides as a primary source of fat. You and your child's doctor and dietitian will make changes to your child's diet as needed.
The diet mimics some effects of fasting on the body. Glucose (sugar) is the easiest source of energy for the body. Most of the glucose comes from carbohydrates that we eat. Once the glucose is burned off, the body uses fat as a source of energy. The use of fat creates a by-product called ketones. For reasons not completely understood, the ketones may reduce or eliminate seizures. Your body will also use body fat for fuel when you fast, but fasting is clearly not a long term option. Having a diet with a high amount fat will have a similar effect of increasing ketone production.
Any dietary change is difficult. The range of food in this diet is somewhat limited, so some find it easier than others to complete the process. To get the most benefit, it is important to follow the diet as closely as possible.
The transition to this diet will be monitored by a doctor. Your child will also be tested on a regular basis to look for side effects and maintain body function. If your child is not seeing a benefit, then the doctor may stop the diet and try alternative treatments.
What kinds of foods will your child be able to eat? Focus on what can be eaten, rather that what cannot be eaten. Keep in mind that the ketogenic diet is fat-based, so fatty foods rule the menu. You can be as creative as you want as long as you are mindful of what your child can eat. Here is a list of possible menu items:
There is more to the diet than just the food. The fat-based menu does have side effects that may appear within a few days. The good news is they are short term and should disappear as your child's body adjusts to the diet. Keep an eye on your child's progress and discuss it with your child's doctor.
Heart disease as an adult is a potentially harmful side effect of eating a high-fat diet. Cholesterol and triglycerides are fats in the blood. High levels can increase the risk of future heart disease. Although the diet leads to significant elevations of fatty substances in the blood, the diet has not been proven to be unsafe. For many, the benefit of reducing or eliminating seizures outweigh the potential of a possible harm developing later in life.
The Epilepsy Foundation
Kids Health—Nemours Foundation
The Center for Epilepsy and Seizure Education
Classic ketogenic and modified ketogenic. The Charlie Foundation website. Available at: http://www.charliefoundation.org/explore-ketogenic-diet/explore-2/classic-ketogenic. Accessed October 11, 2016.
Epilepsy. Kids Health—Nemours Foundation website. Available at http://kidshealth.org/parent/medical/brain/epilepsy.html. Updated June 2016. Accessed October 11, 2016.
Epilepsy: frequently asked questions. Centers for Disease Control and Prevention website. Available at http://www.cdc.gov/epilepsy/basics/faqs.htm. Updated July 18, 2016. Accessed October 11, 2016.
Ketogenic diet in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T270057/Ketogenic-diet-in-children. Updated May 12, 2016. Accessed October 11, 2016.
Kwiterovich P, Vining E, Pyzik P, et al. Effect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA. 2003;290:912-920.
Lefevere F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Pediatrics. 2000;105:e46.
LGS: dietary treatments. Epilepsy Foundation website. Available at http://www.epilepsy.com/information/lennox-gastaut-syndrome/treatment-overview/lgs-dietary-treatments. Accessed October 11, 2016.
Nephrolithiasis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis. Updated July 12, 2016. Accessed October 11, 2016.
What is the ketogenic diet? The Charlie Foundation website. Available at: http://www.charliefoundation.org/explore-ketogenic-diet/explore-1/introducing-the-diet. Accessed October 11, 2016.
5/14/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T270057/Ketogenic-diet-in-children: Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 May 2. [Epub ahead of print]
Last reviewed October 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.