Effect of Ketogenic Diet in Treatment of Refractory Epilepsy

Epilepsy is a chronic disease with onset in infancy affecting 0. 5-1% of the population. One third of the patients are refractory to antiepileptic drugs and they pose a challenge for the health care team. Ketogenic diet is an effective treatment for refractory epilepsy. The ketogenic diet is a very low carbohydrate، high fat، and low to adequate protein diet that includes some restriction of total calories (≈75% of age rec­ommendations). The amount of protein is based on age requirement، carbohydrates are only 5 to 10 g/day، and the remaining calories come from fat. The ratio of fat to protein plus carbohydrate ranges from 2:1 to 4:1. The mechanism of the ketogenic diet is not well under­stood. Its benefit may be related to acidosis، ketosis، calorie restriction and decrease in blood glucose، dehydration، or increase in certain lipids. A ketogenic diet limits blood glucose، and produces ketone bodies from β-oxidation of lipids. Studies have explored changes in ketone bodies and/or glucose in the effects of the ketogenic diet، and glucose is increasingly implicated in neurological conditions. Some studies reveal that a ketogenic diet sensitizes glucose-based regulation of excitability via purinergic mechanisms in the hippocampus. Adverse effects of the ketogenic diet include constipation and worsening of reflux، acidosis، unexplained fatigue and renal calculi. The potential adverse effect of decreased growth is most likely to occur in the youngest chil­dren.