Position Statement on the Use of Diet Therapies for Pediatric Epilepsy

The ketogenic diet has consistently been documented to effectively treat epilepsy in thousands of children since 1924. In the last fifteen years over 750 peer-reviewed articles regarding its success, implementation, and scientific mechanisms have been published. Two major reports which included 44 reviews of over one thousand children who received ketogenic diet treatment confirmed that at least half benefited with a 50% or greater improvement in seizure control. ^1,2 One controlled and randomized (Class 1) study published in 2008 also provided the long awaited scientific proof that the ketogenic diet is an effective therapy and a valid option for treatment of epilepsy. ³ A 2008 consensus report from 26 worldwide experts concluded that the ketogenic diet "should be offered to a child after two anticonvulsants (medications) are used unsuccessfully." ⁴

It is our belief that this therapy has stood the test of time. The concern that it is "too difficult" should not be judged by the health care provider, but rather the family equipped with sufficient knowledge of the diet.

There are two newer diet therapies that have been developed in recent years—the Low Glycemic Index Treatment and modified Atkins diet. At this time the evidence reveals positive results, however these newer therapies have been studied in small numbers, over short periods of time, and should be reserved for when the ketogenic diet is not an option. There are many instances in which children with some improvement with these alternate diets have achieved greater seizure control when transitioned to the ketogenic diet, but the opposite is not true. Ultimately it is our hope that the therapy for each child be determined through a careful process of informed joint decision making between families and their health care providers.

1. Lefevre F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: a systematic review of efficacy. Pediatrics. 2000;105(4):e46.
2. Henderson CB, Filloux FM, Alder SC, Lyon JL, Caplin DA. Efficacy of the ketogenic diet as a treatment option for epilepsy:meta-analysis. J Child Neurol. 2006;21(3):193-198.
3. Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008;7(6):500-506.
4. Kossoff EH, Zupec-Kania BA, Amark PE, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the international ketogenic diet study group. Epilepsia. 2009;50(2):304-317.