Ketogenic Diet

When a child’s epilepsy and seizures do not respond to medicines, eating a ketogenic diet may help reduce the frequency of seizures. A ketogenic diet is an eating plan that is high in fats, supplies adequate protein and is very low in carbohydrates. The ketogenic diet requires precise measurement of foods and is only used under medical supervision.

Eating a high fat, low carbohydrate diet changes the way energy is used in the body. The liver turns the fat into fatty acids and ketone bodies, which are used as energy instead of carbohydrates. A higher level of ketone bodies in the blood helps reduce the number of seizures.

Types of seizures that respond well to a ketogenic diet include:

Uncontrolled seizures (seizures that do not respond to medicines)
Generalized seizures (these affect the whole brain or a large part of it and can affect consciousness)
Tonic seizures (the body and limbs stiffen during the seizure)
Absence seizures (sudden, short episodes of blanking out)
Infantile spasms (a form of generalized seizure that occurs in infancy)

When children begin a ketogenic diet under the care of doctors at Riley at IU Health, they are admitted to the hospital for close monitoring by the ketogenic therapy team, which includes a neurologist, dietitian, pharmacist and nurse. The child will fast by eating nothing after midnight. During the hospital stay, parents are taught how to prepare ketogenic meals and how to monitor their child’s nutrition.

A ketogenic diet can be challenging, as it requires strict compliance and patience. It takes three months to adjust to a ketogenic eating plan:

One month to learn how to weigh or prepare meals
One month to fine-tune the diet
One month to get used to the new way of eating

In some cases, the less restrictive modified Atkins diet (MAD) may be recommended instead. This eating plan does not require a hospital stay and can be followed without the need to measure or weigh food and count calories. The MAD should still be used under medical supervision as blood draws are needed to monitor a child’s progress. The modified Atkins diet generally lowers seizure rates within a few months.

The ketogenic therapy team at Riley at IU Health will work closely with you and your child to help you follow this nutritional plan. Once the ketogenic diet is fine-tuned to your child's specific needs, he or she will meet with the ketogenic therapy team once every three to six months for monitoring and to make any needed adjustments.

More than half of all children who go on the ketogenic diet see a 50 percent reduction in the number of seizures. Between 10 and 15 percent of children become seizure-free.

What to Expect

If your child’s epilepsy does not respond to other treatments, his or her neurologist may refer you to the ketogenic therapy team. You and your child will meet with a neurologist and dietitians who will explain how the ketogenic diet works.

You can expect the following before your child starts a ketogenic diet:

You and your child will meet with the ketogenic therapy team to discuss your child’s medical and seizure history and to go over the ketogenic diet process.
The neurologist will order certain tests and lab work to ensure the ketogenic diet will be effective. These tests include blood tests and a urinalysis to ensure your child is healthy.

You can expect the following when your child begins a ketogenic diet:

Your child will be admitted to the hospital. The hospital stay will last three to four days.
Your child will fast after midnight (water is allowed).
During this time, doctors will teach your family how to prepare meals and check for safe levels of ketones in the urine (while the ketogenic diet relies on higher levels of ketones in the urine, very high levels of ketones are not safe).
Your child will be monitored to see how his or her body responds to the diet.
If everything goes well, your child will go home with instructions on how to continue the diet at home.

You can expect the following in the months after your child begins a ketogenic diet:

Your child will attend regular follow-up visits with the ketogenic therapy team every three to six months.
The doctor will order blood and urine tests at each follow-up visit to check on your child’s health.
Because the ketogenic diet does not supply all the nutrients growing children need, the doctor will prescribe certain vitamins and supplements.

If your child is using the modified Atkins diet:

No hospitalization is needed to begin the diet.
Patient and family education takes place on an outpatient basis.
Follow-up appointments and lab work take place every three to six months.

Key Points to Remember

The ketogenic diet is used to reduce the seizure rate in children whose seizures do not respond to medicines.
The ketogenic diet is a high fat, adequate-protein, very low carbohydrate diet.
Your child will be admitted to the hospital before beginning the ketogenic diet eating plan.
More than half of children who use the ketogenic diet see a 50 percent reduction in their seizure rate. Some become seizure-free.
The less restrictive modified Atkins diet is also successful at lowering the number of seizures for children whose seizures do not respond to medicines.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.