Dietary therapy in childhood epilepsy, an overview

This review highlights the current consensus guidelines regarding use of dietary therapy in childhood epilepsy. Comprehensive search was done in the electronic database, journals, reference lists and dissertations related to the field. In childhood epilepsy, about one-third patients are medically refractory. Surgical resection is an effective modality only in a third of these cases. Dietary therapy causes upto 30–40% reduction in seizure frequency in drug refractory epilepsy. The various forms of dietary therapies described are ketogenic diet, modified Atkins diet and low glycemic index treatment. Apart from ketogenesis, the ketogenic diet also exerts its effect by modulating brain energetics and neurotransmitter circuitry. The classical ketogenic diet comprises of fat to carbohydrate ratio of 4:1 (in terms of weight in grams). Modified Atkins diet is restrictive only for carbohydrates (≤20 g per day). Low glycemic index treatment allows carbohydrate of upto 60 g per day with food items having glycemic index of less than 50. Consensus recommendations for indications and contraindications of dietary therapy in childhood epilepsy have been formulated. Moreover caution has to be warranted for various metabolic and systemic side effects described with this form of therapy. Laboratory and clinical assessment prior to initiation and periodically on therapy is recommended. A trial of dietary therapy is labeled as failure only if there is no response even after 12 weeks of therapy. There is research ongoing globally on dietary therapy with preliminary encouraging reports in status epilepticus and other neurological conditions like migraine, brain tumor and autism.