DIETARY THERAPY OF EPILEPSY IN THE 90S - RENEWED EXPERIENCE WITH THE KETOGENIC DIET

From a serendipitous observation that fasting temporarily suppresses e pileptic seizures, arose the idea that a diet would mimic the metaboli c effects of ketosis. The so named ''ketogenic diet'' has enjoyed a re newal of interest amongst physicians and the public in recent years, p artly because of dramatic proclamation by the media that a miracle cur e has been long ignored by the medical establishment. The efficacy of the ketogenic diet until recently has not been rigorously examined thr ough scientific trials. We examine the historical precedent to the use of the ketogenic diet as treatment for epileptic seizures, and critic ally review previous and current research regarding its efficacy and m echanisms of action. Despite the efficacy of the diet in a wide variet y of difficult to treat epileptic seizures in children and adults, the re remain several limitations. Although a metabolic adaptation within the brain is thought to be responsible for its action, the precise mec hanisms at a cellular level remain poorly understood. Further research on the ketogenic diet needs to focus on precisely defining indication s, mechanisms of action, safety and impact on quality of life in epile psy. (C) 1998 Elsevier Science Inc.