Diet therapy in refractory pediatric epilepsy: Increased efficacy and tolerability

Since the resurgence of the ketogenic diet (KD) in the mid 1990s, this diet has been used worldwide for the treatment of refractory pediatric epilepsy, including in Asian countries. However, the KD is not a convenient therapy, especially because the customary diets of Asian countries contain substantially less fat than traditional Western diets. In addition, there are various complications associated with the diet that should be considered. Unfortunately, no international protocols have been developed with the exceptions of the Johns Hopkins Hospital protocol adopted by a substantial number of hospitals. While the Hopkins protocol has been the basic model, several revisions of the initial protocol have been suggested. Changes to the applicable ages, seizure types, etiologies, the initiation of the diet, the ratio of constituents to reduce the fat content, the duration of the diet, and revised formulae, such as ketogenic milk or the all-liquid KD, have attempted to extend the indications of the KD and increase its tolerability and palatability. Recently, less restrictive KDs, including a modified Atkins diet and low-glycemic-index treatment, have been clinically tested. Here, we review these approaches toward a safer and more convenient therapeutic diet for refractory pediatric epilepsy.ope