A ketogenic diet:: Is this a valid alternative in refractory epilepsy?

Introduction. The ketogenic diet was first used in refractory epilepsy of childhood in the early 1920s. It was forgotten when new antiepileptic drugs were introduced, but recently has been used again. Although its efficacy in the treatment of epilepsy, in some patients, is beyond doubt, its mechanism of action is still not clear. There are three types of diet: the classical diet with a proportion of 4:1 of long chain fatty acids, with MCT oil and with modified MCT oil. Objective. To present a protocol recently designed in our hospital. We include the type of diet form of onset, subsequent follow-up of complications, clinical and electro-encephalographic response and side-effects seen in the patients. Patients and methods. Introduction of the ketogenic diet with MCT oil in six patients aged between 2 and I I years, with various types of epilepsy, all resistant to treatment, who had been unsuccessfully treated for 28 months in one case and between 4 and 6 months in the others. We evaluated the response on the criteria of Huttenlocher and Panic electroencephalograms. Results. Two of the patients improved with good control of their disorder and the EEG became normal. No serious side-effects were seen apart from gastrointestinal symptoms which improved when the quantity of MCT oil was reduced. Conclusions. Inpatients with drug-resistant epilepsy it is convenient to have a guideline for treatment using a ketogenic diet. It is also useful to have a multi-disciplinary team for management, follow-up to detect late side-effects and obtain the cooperation of the patient's family in following the protocol.