Epilepsi Tedavisinde Medikal Ketojenik Diyet
Özet
Epilepsi çocuklardaki en sık nörolojik hastalıktır. Epilepside anti nöbet ilaçlar birinci tedavi seçeneğidir ancak ilaca dirençli epilepside, ketojenik diyet de etkili bir tedavi seçeneği olarak karşımıza çıkmaktadır. Ketojenik diyet temelde düşük karbonhidrat ve yüksek yağ içeren bir diyettir. Bu bölümde ketojenik diyet tedavisinin kullanım endikasyonlarını, kontrendikasyonlarını, ketojenik diyete başlamadan önceki değerlendirme ve tetkikleri, ketojenik diyet alan hastaların takibini, diyetin olası yan etkilerini ve diyetin kesilmesi sırasındaki önerileri tartıştık.
Epilepsy is the most common neurological disorder in children. While anti-seizure medications are the first treatment option for epilepsy, the ketogenic diet emerges as an effective treatment option for drug-resistant epilepsy. The ketogenic diet is fundamentally a low-carbohydrate and high-fat diet. In this section, we discuss the indications for ketogenic diet therapy, explain contraindications, pre-diet evaluation and tests, follow-up of patients on the ketogenic diet, possible side effects of the diet and recommendations for discontinuing the diet.
Referanslar
Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology. 2017;88:296-303.
Serdaroglu A, Ozkan S, Aydin K, Gucuyener K, Tezcan S, Aycan S. Prevalence of Epilepsy in Turkish Children Between the Ages of 0 and 16 Years. J Child Neurol. 2004;19:271-274.
Sillanpaa M, Schmidt D. Natural history of treated childhood-onset epilepsy: prospective,long-term population-based study. Brain. 2006;129:617-624.
Kossoff EH, McGrogan JR, Bluml RM, et al. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia 2006;47:421–424.
Pfeifer HH, Thiele EA. Low‐glycemic‐index treatment: a liberalized ketogenic diet for treatment of intractable epilepsy. Neurology 2005;65:1810–1812.
Kossoff EH, Zupec-Kania BA, Auvin S, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;3:175-192.
Dressler A, Trimmel‐Schwahofer P, Reithofer E, et al. The ketogenic diet in infants—Advantages of early use. Epilepsy Res 2015;116:53–58.
Kim JA, Yoon JR, Lee EJ, et al. Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy. Epilepsia 2016;57:51–58.
van der Louw E, van den Hurk D, Neal E, et al. Ketogenic diet guidelines for infants with refractory epilepsy. Eur J Paediatr Neurol 2016;20:798–809.
Kass HR, Winesett SP, Bessone SK, et al. Use of dietary therapies amongst patients with GLUT1 deficiency syndrome. Seizure 2016; 35:83.
Sofou K, Dahlin M, Hallbook T, et al. Ketogenic diet in pyruvate dehydrogenase complex deficiency: short- and long-term outcomes. J Inherit Metab Dis 2017;40:237-245.
Guzin Y., Yilmaz U. (2021). Epilepsi Tedavisinde Ketojenik Diyet Uygulamaları ve Etkinliği. In: Yilmaz U., Unalp A. (eds) Çocukluk çağı epilepsilerinde Ketojenik Diyet Tedavisi. Akademisyen Kitabevi, Ankara. 2021. ss: 45-56.
Karaoglu P. (2021). Ketojenik Diyetin Endikasyonları ve Kontrendikasyonları. In: Yilmaz U., Unalp A. (eds) Çocukluk çağı epilepsilerinde Ketojenik Diyet Tedavisi. Akademisyen Kitabevi, Ankara. 2021. ss: 31-44.
Dressler A, Trimmel-Schwahofer P, Reithofer E, et al. Efficacy and tolerability of the ketogenic diet in Dravet syndrome-Comparison with various standard antiepileptic drug regimen.Epilepsy Res 2015;109:81-89.
Oguni H, Tanaka T, Hayashi, et al. Treatment and long term prognosis of myoclonic-astatic epilepsy of early childhood. Neuropediatrics 2002;33:122-132 .
Kilaru S, Bergqvist AG. Current treatment of myoclonic astatic epilepsy: clinical experience at the children’s hospital of Philadelphia. Epilepsia 2007;48:1703-1707.
Caraballo RH, Cersosimo RO, Sakr D, et al. Ketogenic diet in patients with myoclonic‐astatic epilepsy. Epileptic Disord 2006;8:151–155.
Eun SH, Kang HC, Kim DW, et al. Ketogenic diet for treatment of infantile spasms. Brain Dev 2006;28:566-571
Hong AM, Turner Z, Hamdy RF, et al. Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants. Epilepsia 2010;51:1403-1407.
Kossoff EH, Thiele EA, Pfeifer HH, McGrogan JR, Freeman JM. Tuberous sclerosis complex and the ketogenic diet. Epilepsia. 2005;46:1684-1686.
Coppola G, Klepper J, Ammendola E, et al. The effects of the ketogenic diet in refractory partial seizures with reference to tuberous sclerosis. Eur J Paediatr Neurol 2006;10:148-151.
Kossoff EH, Turner Z, Bergey GK. Home-guided use of the ketogenic diet in a patient for over twenty years. Pediatr Neurol; 36:424-425.
Ismail FY, Kossoff EH. AERRPS, DESC, NORSE, FIRES: multi-labeling or distinct epileptic entities? Epilepsia 2011;52:e185-e189
Millichap JJ, Millichap JG. Ketogenic diet as preferred treatment of FIRES. Pediatr Neurol Briefs 2015;29:3.
Nabbout R, Mazzuca M, Hubert P, et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia 2010;51:2033–2037.
Singh RK, Joshi SM, Potter DM, et al. Cognitive outcomes in febril infection-related epilepsy syndrome treated with the ketogenic diet. Pediatrics 2014;134:e1431-e1435.
Hosain SA, La Vega-Talbott M, Solomon GE. Ketogenic diet in pediatric epilepsy patients with gastrostomy feeding. Pediatr Neurol 2005;32:81-83.
Kossoff EH, McGrogan JR, Freeman JM. Benefits of an all‐liquid ketogenic diet. Epilepsia 2004;45:1163.
Sivaraju A, Nussbaum I, Cardoza CS, et al. Substantial and sustained seizure reduction with ketogenic diet in a patient with Ohtahara syndrome. Epilepsy Behav Case Rep 2015;3:43–45.
Seo JH, Lee YM, Lee JS, et al. A case of Ohtahara syndrome with mitochondrial respiratory chain complex I deficiency. Brain Dev 2010;32:253–257.
Ishii M, Shimono M, Senju A, et al. The ketogenic diet as an effective treatment for Ohtahara syndrome. No To Hattatsu 2011;43:47–50.
Thakur KT, Probasco JC, Hocker SE, et al. Ketogenic diet for adults in super‐refractory status epilepticus. Neurology 2014;82:665–670.
Caraballo R, Darra F, Reyes G, et al. The ketogenic diet in patients with myoclonic status in non‐progressive encephalopathy. Seizure 2017;51:1–5.
Kang HC, Lee YM, Kim HD, et al. Safe and effective use of the ketogenic diet in children with epilepsy and mitochondrial respiratory chain complex defects. Epilepsia 2007;48:82–88.
Grocott OR, Herrington KS, Pfeifer HH, et al. Low glycemic index treatment for seizure control in Angelman syndrome: A case series from the Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital. Epilepsy Behav 2017;68:45–50.
Evangeliou A, Doulioglou V, Haidopoulou K, et al. Ketogenic diet in a patient with Angelman syndrome. Pediatr Int 2010;52:831–834.
Cardinali S, Canafoglia L, Bertoli S, et al. A pilot study of a ketogenic diet in patients with Lafora body disease. Epilepsy Res 2006;69:129–134.
Liebhaber GM, Riemann E, Baumeister FA. Ketogenic diet in Rett syndrome. J Child Neurol 2003;18:74–75.
Giampietro PF, Schowalter DB, Merchant S, et al. Widened clinical spectrum of the Q128P MECP2 mutation in Rett syndrome. Childs Nerv Syst 2006;22:320–324.
Bergqvist AG, Chee CM, Lutchka LM, et al. Treatment of acquired epileptic aphasia with the ketogenic diet. J Child Neurol 1999;14:696–701.
Bautista RE. The use of the ketogenic diet in a patient with subacute sclerosing panencephalitis. Seizure 2003;12:175–177.
Swoboda KJ, Specht L, Jones HR, et al. Infantile phosphofructokinase deficiency with arthrogryposis: clinical benefit of a ketogenic diet. J Pediatr 1997;131:932–934.
Jurecka A, Opoka‐Winiarska V, Rokicki D, et al. Neurologic presentation, diagnostics, and therapeutic insights in a severe case of adenylosuccinate lyase deficiency. J Child Neurology 2012;27:645–649.
Busch V, Gempel K, Hack A, et al. Treatment of glycogenosis type V with ketogenic diet. Ann Neurol 2005;58:341.
Kossoff EH, Henry BJ, Cervenka MC. Efficacy of dietary therapy for juvenile myoclonic epilepsy. Epilepsy Behav 2013;26:162–164.
Lim Z, Wong K, Olson HE, et al. Use of the ketogenic diet to manage refractory epilepsy in CDKL5 disorder: Experience of >100 patients. Epilepsia 2017;58:1415–1422.
Caraballo R, Noli D, Cachia P. Epilepsy of infancy with migrating focal seizures: three patients treated with the ketogenic diet. Epileptic Disord 2015;17:194–197.
Groomes LB, Pyzik PL, Turner Z, et al. Do patients with absence epilepsy respond to ketogenic diets? J Child Neurol 2011;26:160–165.
Kelley SA, Kossoff EH. How effective is the ketogenic diet for electrical status epilepticus of sleep? Epilepsy Res 2016;127:339–343.
Stainman RS, Turner Z, Rubenstein JE, et al. Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy. Seizure 2007;16:615–619.
Unalp A. Cocukluk cağı epilepsilerinde ketojenik diyet uygulamaları. Izmir Dr. Behcet Uz Cocuk Hast. Dergisi 2017;7:169-177.
Schwartz RH, Eaton J, Bower BD, et al. Ketogenic diets in the treatment of epilepsy: short‐term clinical effects. Dev Med Child Neurol 1989;1:145–151.
Neal EG, Chaffe H, Schwartz RH, et al. A randomized trial of classical and medium‐chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia 2009;50:1109–1117.
Kang HC, Lee HS, You SJ, et al. Use of a modified Atkins diet in intractable childhood epilepsy. Epilepsia 2007;48:182–186.
Kossoff EH, Turner Z, Bluml RM, et al. A randomized, crossover comparison of daily carbohydrate limits using the modified Atkins diet. Epilepsy Behav 2007;10:432–436.
Bansal S, Cramp L, Blalock D, et al. The ketogenic diet: initiation at goal calories versus gradual caloric advancement. Pediatr Neurol 2014;50:26–30.
Bergqvist AG, Schall JI, Gallagher PR, et al. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia 2005;46:1810–1819.
Wirrell EC, Darwish HZ, Williams‐Dyjur C, et al. Is a fast necessary when initiating the ketogenic diet? J Child Neurol 2002;17:179–182.
Kossoff EH, Pyzik PL, Rubenstein JE, et al. Combined ketogenic diet and vagus nerve stimulation: rational polytherapy? Epilepsia 2007;48:77–81.
Dahlin MG, Beck OM, Amark PE. Plasma levels of antiepileptic drugs in children on the ketogenic diet. Pediatr Neurol 2006;35:6–10.
Coppola G, Verrotti A, D'Aniello A, et al. Valproic acid and phenobarbital blood levels during the first month of treatment with the ketogenic diet. Acta Neurol Scand 2010;122:303–307.
Heo G, Kim SH, Chang MJ. Effect of ketogenic diet and other dietary therapies on anti‐epileptic drug concentrations in patients with epilepsy. J Clinc Pharm Ther 2017;42:758–764.
Lyczkowski DA, Pfeifer HH, Ghosh S, et al. Safety and tolerability of the ketogenic diet in pediatric epilepsy: effects of valproate combination therapy. Epilepsia 2005;46:1533–1538.
Spilioti M, Pavlou E, Gogou M, et al. Valproate effect on ketosis in children under ketogenic diet. Eur J Paediatr Neurol 2016;20:555–559.
Coppola G, Epifanio G, Auricchio G, et al. Plasma free carnitine in epilepsy children, adolescents and young adults treated with old and new antiepileptic drugs with or without ketogenic diet. Brain Dev 2006;28:358–365.
McNally MA, Pyzik PL, Rubenstein JE, et al. Empiric use of oral potassium citrate reduces symptomatic kidney stone incidence with the ketogenic diet. Pediatrics 2009;124:e300–e304.
Huttenlocher P. Ketonemia and seizures: Metabolic and anticonvulsant effects of two ketogenic diets in childhood epilepsy. Pediatr Res 1976;10:536–540.
Lebel D, Morin C, Laberge M, et al. The carbohydrate and caloric content of concomitant medications for children with epilepsy on the ketogenic diet. Can J Neurol Sci 2001;28:322–340.
Kossoff EH, Pyzik PL, McGrogan JR, et al. Impact of early versus late anticonvulsant reduction after ketogenic diet initiation. Epilepsy Behav 2004;5:499–502.
Bergqvist AG, Chee CM, Lutchka L, et al. Selenium deficiency with cardiomyopathy: a complication of the ketogenic diet. Epilepsia 2003;44:618–620.
Bank IM, Shemie SD, Rosenblatt B, et al. Sudden cardiac death in association with the ketogenic diet. Pediatr Neurol 2008;39:429–431.
Sirikonda NS, Patten WD, Phillips JR, et al. Ketogenic diet: rapid onset of selenium deficiency‐induced cardiac decompensation. Pediatr Cardiol 2012;33:834–838.
Benn A, Swan CHJ, Cooke WT, et al. Effect of intraluminal pH on the absorption of pteroylmonoglutamic acid. British Med J 1971;1:148–150.
Lin A, Turner Z, Doerrer SC, et al. Complications during ketogenic diet initiation: prevalence, treatment, and influence on seizure outcomes. Pediatr Neurol 2017;68:35–39.
Kang HC, Chung DE, Kim DW, et al. Early and late‐onset complications of the ketogenic diet for intractable epilepsy. Epilepsia 2004;45:1116–1123.
Caraballo R, Vaccarezza M, Cersósimo R, et al. Long‐term follow‐up of the ketogenic diet for refractory epilepsy: multicenter Argentinean experience in 216 pediatric patients. Seizure 2011;20:640–645.
Kwiterovich PO Jr, Vining EP, Pyzik P, et al. Effect of a high‐fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA 2003;290:912–920.
Nizamuddin J, Turner Z, Rubenstein JE, et al. Management and risk factors for dyslipidemia with the ketogenic diet. J Child Neurol 2008;23:758–761.
Guzel O, Yılmaz U, Uysal U, et al. The effect of olive oil‐based ketogenic diet on serum lipid levels in epileptic children. Neurol Sci 2016;37:465–470.
Groesbeck DK, Bluml RM, Kossoff EH. Long‐term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol 2006;48:978–981.
Vining EP, Pyzik P, McGrogan J, et al. Growth of children on the ketogenic diet. Dev Med Child Neurol 2002;44:796–802.
Williams S, Basualdo‐Hammond C, Curtis R, et al. Growth retardation in children with epilepsy on the ketogenic diet: a retrospective chart review. J Am Diet Assoc 2002;102:405–407.
Peterson SJ, Tangney CC, Pimentel‐Zablah EM, et al. Changes in growth and seizure reduction in children on the ketogenic diet as a treatment for intractable epilepsy. J Am Diet Assoc 2005;105:718–725.
Kossoff EH, Pyzik PL, Furth SL, et al. Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet. Epilepsia 2002;43:1168–1171.
Sampath A, Kossoff EH, Furth SL, et al. Kidney stones and the ketogenic diet: risk factors and prevention. J Child Neurol 2007;22:375–378.
Furth SL, Casey JC, Pyzik PL, et al. Risk factors for urolithiasis in children on the ketogenic diet. Pediatric Nephrol 2000;15:125–128.
Guzin Y, Yılmaz U, Devrim F, Dincel N, Unalp A. Kidney Stones in Epileptic Children Receiving Ketogenic Diet: Frequency and Risk Factors. Neuropediatrics. 2023 Oct;54(5):308-314.
Best TH, Franz DN, Gilbert DL, et al. Cardiac complications in pediatric patients on the ketogenic diet. Neurology 2000;54:2328–2330.
Sharma S, Gulati S. The ketogenic diet and the QT interval. J Clin Neurosci 2012;18:181–182.
Stevens CE, Turner Z, Kossoff EH. Hepatic dysfunction as a complication of combined ketogenic diet and valproic acid. Pediatr Neurol 2016;54:82–84.
Ballaban‐Gil K, Callahan C, O'Dell C, et al. Complications of the ketogenic diet. Epilepsia 1998;39:744–748.
Kossoff EH, Laux LC, Blackford R, et al. When do seizures improve with the ketogenic diet? Epilepsia 2008;49:329–333.
Martinez CC, Pyzik PL, Kossoff EH. Discontinuing the ketogenic diet in seizure‐free children: recurrence and risk factors. Epilepsia 2007;48:187–190.
Referanslar
Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology. 2017;88:296-303.
Serdaroglu A, Ozkan S, Aydin K, Gucuyener K, Tezcan S, Aycan S. Prevalence of Epilepsy in Turkish Children Between the Ages of 0 and 16 Years. J Child Neurol. 2004;19:271-274.
Sillanpaa M, Schmidt D. Natural history of treated childhood-onset epilepsy: prospective,long-term population-based study. Brain. 2006;129:617-624.
Kossoff EH, McGrogan JR, Bluml RM, et al. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia 2006;47:421–424.
Pfeifer HH, Thiele EA. Low‐glycemic‐index treatment: a liberalized ketogenic diet for treatment of intractable epilepsy. Neurology 2005;65:1810–1812.
Kossoff EH, Zupec-Kania BA, Auvin S, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;3:175-192.
Dressler A, Trimmel‐Schwahofer P, Reithofer E, et al. The ketogenic diet in infants—Advantages of early use. Epilepsy Res 2015;116:53–58.
Kim JA, Yoon JR, Lee EJ, et al. Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy. Epilepsia 2016;57:51–58.
van der Louw E, van den Hurk D, Neal E, et al. Ketogenic diet guidelines for infants with refractory epilepsy. Eur J Paediatr Neurol 2016;20:798–809.
Kass HR, Winesett SP, Bessone SK, et al. Use of dietary therapies amongst patients with GLUT1 deficiency syndrome. Seizure 2016; 35:83.
Sofou K, Dahlin M, Hallbook T, et al. Ketogenic diet in pyruvate dehydrogenase complex deficiency: short- and long-term outcomes. J Inherit Metab Dis 2017;40:237-245.
Guzin Y., Yilmaz U. (2021). Epilepsi Tedavisinde Ketojenik Diyet Uygulamaları ve Etkinliği. In: Yilmaz U., Unalp A. (eds) Çocukluk çağı epilepsilerinde Ketojenik Diyet Tedavisi. Akademisyen Kitabevi, Ankara. 2021. ss: 45-56.
Karaoglu P. (2021). Ketojenik Diyetin Endikasyonları ve Kontrendikasyonları. In: Yilmaz U., Unalp A. (eds) Çocukluk çağı epilepsilerinde Ketojenik Diyet Tedavisi. Akademisyen Kitabevi, Ankara. 2021. ss: 31-44.
Dressler A, Trimmel-Schwahofer P, Reithofer E, et al. Efficacy and tolerability of the ketogenic diet in Dravet syndrome-Comparison with various standard antiepileptic drug regimen.Epilepsy Res 2015;109:81-89.
Oguni H, Tanaka T, Hayashi, et al. Treatment and long term prognosis of myoclonic-astatic epilepsy of early childhood. Neuropediatrics 2002;33:122-132 .
Kilaru S, Bergqvist AG. Current treatment of myoclonic astatic epilepsy: clinical experience at the children’s hospital of Philadelphia. Epilepsia 2007;48:1703-1707.
Caraballo RH, Cersosimo RO, Sakr D, et al. Ketogenic diet in patients with myoclonic‐astatic epilepsy. Epileptic Disord 2006;8:151–155.
Eun SH, Kang HC, Kim DW, et al. Ketogenic diet for treatment of infantile spasms. Brain Dev 2006;28:566-571
Hong AM, Turner Z, Hamdy RF, et al. Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants. Epilepsia 2010;51:1403-1407.
Kossoff EH, Thiele EA, Pfeifer HH, McGrogan JR, Freeman JM. Tuberous sclerosis complex and the ketogenic diet. Epilepsia. 2005;46:1684-1686.
Coppola G, Klepper J, Ammendola E, et al. The effects of the ketogenic diet in refractory partial seizures with reference to tuberous sclerosis. Eur J Paediatr Neurol 2006;10:148-151.
Kossoff EH, Turner Z, Bergey GK. Home-guided use of the ketogenic diet in a patient for over twenty years. Pediatr Neurol; 36:424-425.
Ismail FY, Kossoff EH. AERRPS, DESC, NORSE, FIRES: multi-labeling or distinct epileptic entities? Epilepsia 2011;52:e185-e189
Millichap JJ, Millichap JG. Ketogenic diet as preferred treatment of FIRES. Pediatr Neurol Briefs 2015;29:3.
Nabbout R, Mazzuca M, Hubert P, et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia 2010;51:2033–2037.
Singh RK, Joshi SM, Potter DM, et al. Cognitive outcomes in febril infection-related epilepsy syndrome treated with the ketogenic diet. Pediatrics 2014;134:e1431-e1435.
Hosain SA, La Vega-Talbott M, Solomon GE. Ketogenic diet in pediatric epilepsy patients with gastrostomy feeding. Pediatr Neurol 2005;32:81-83.
Kossoff EH, McGrogan JR, Freeman JM. Benefits of an all‐liquid ketogenic diet. Epilepsia 2004;45:1163.
Sivaraju A, Nussbaum I, Cardoza CS, et al. Substantial and sustained seizure reduction with ketogenic diet in a patient with Ohtahara syndrome. Epilepsy Behav Case Rep 2015;3:43–45.
Seo JH, Lee YM, Lee JS, et al. A case of Ohtahara syndrome with mitochondrial respiratory chain complex I deficiency. Brain Dev 2010;32:253–257.
Ishii M, Shimono M, Senju A, et al. The ketogenic diet as an effective treatment for Ohtahara syndrome. No To Hattatsu 2011;43:47–50.
Thakur KT, Probasco JC, Hocker SE, et al. Ketogenic diet for adults in super‐refractory status epilepticus. Neurology 2014;82:665–670.
Caraballo R, Darra F, Reyes G, et al. The ketogenic diet in patients with myoclonic status in non‐progressive encephalopathy. Seizure 2017;51:1–5.
Kang HC, Lee YM, Kim HD, et al. Safe and effective use of the ketogenic diet in children with epilepsy and mitochondrial respiratory chain complex defects. Epilepsia 2007;48:82–88.
Grocott OR, Herrington KS, Pfeifer HH, et al. Low glycemic index treatment for seizure control in Angelman syndrome: A case series from the Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital. Epilepsy Behav 2017;68:45–50.
Evangeliou A, Doulioglou V, Haidopoulou K, et al. Ketogenic diet in a patient with Angelman syndrome. Pediatr Int 2010;52:831–834.
Cardinali S, Canafoglia L, Bertoli S, et al. A pilot study of a ketogenic diet in patients with Lafora body disease. Epilepsy Res 2006;69:129–134.
Liebhaber GM, Riemann E, Baumeister FA. Ketogenic diet in Rett syndrome. J Child Neurol 2003;18:74–75.
Giampietro PF, Schowalter DB, Merchant S, et al. Widened clinical spectrum of the Q128P MECP2 mutation in Rett syndrome. Childs Nerv Syst 2006;22:320–324.
Bergqvist AG, Chee CM, Lutchka LM, et al. Treatment of acquired epileptic aphasia with the ketogenic diet. J Child Neurol 1999;14:696–701.
Bautista RE. The use of the ketogenic diet in a patient with subacute sclerosing panencephalitis. Seizure 2003;12:175–177.
Swoboda KJ, Specht L, Jones HR, et al. Infantile phosphofructokinase deficiency with arthrogryposis: clinical benefit of a ketogenic diet. J Pediatr 1997;131:932–934.
Jurecka A, Opoka‐Winiarska V, Rokicki D, et al. Neurologic presentation, diagnostics, and therapeutic insights in a severe case of adenylosuccinate lyase deficiency. J Child Neurology 2012;27:645–649.
Busch V, Gempel K, Hack A, et al. Treatment of glycogenosis type V with ketogenic diet. Ann Neurol 2005;58:341.
Kossoff EH, Henry BJ, Cervenka MC. Efficacy of dietary therapy for juvenile myoclonic epilepsy. Epilepsy Behav 2013;26:162–164.
Lim Z, Wong K, Olson HE, et al. Use of the ketogenic diet to manage refractory epilepsy in CDKL5 disorder: Experience of >100 patients. Epilepsia 2017;58:1415–1422.
Caraballo R, Noli D, Cachia P. Epilepsy of infancy with migrating focal seizures: three patients treated with the ketogenic diet. Epileptic Disord 2015;17:194–197.
Groomes LB, Pyzik PL, Turner Z, et al. Do patients with absence epilepsy respond to ketogenic diets? J Child Neurol 2011;26:160–165.
Kelley SA, Kossoff EH. How effective is the ketogenic diet for electrical status epilepticus of sleep? Epilepsy Res 2016;127:339–343.
Stainman RS, Turner Z, Rubenstein JE, et al. Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy. Seizure 2007;16:615–619.
Unalp A. Cocukluk cağı epilepsilerinde ketojenik diyet uygulamaları. Izmir Dr. Behcet Uz Cocuk Hast. Dergisi 2017;7:169-177.
Schwartz RH, Eaton J, Bower BD, et al. Ketogenic diets in the treatment of epilepsy: short‐term clinical effects. Dev Med Child Neurol 1989;1:145–151.
Neal EG, Chaffe H, Schwartz RH, et al. A randomized trial of classical and medium‐chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia 2009;50:1109–1117.
Kang HC, Lee HS, You SJ, et al. Use of a modified Atkins diet in intractable childhood epilepsy. Epilepsia 2007;48:182–186.
Kossoff EH, Turner Z, Bluml RM, et al. A randomized, crossover comparison of daily carbohydrate limits using the modified Atkins diet. Epilepsy Behav 2007;10:432–436.
Bansal S, Cramp L, Blalock D, et al. The ketogenic diet: initiation at goal calories versus gradual caloric advancement. Pediatr Neurol 2014;50:26–30.
Bergqvist AG, Schall JI, Gallagher PR, et al. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia 2005;46:1810–1819.
Wirrell EC, Darwish HZ, Williams‐Dyjur C, et al. Is a fast necessary when initiating the ketogenic diet? J Child Neurol 2002;17:179–182.
Kossoff EH, Pyzik PL, Rubenstein JE, et al. Combined ketogenic diet and vagus nerve stimulation: rational polytherapy? Epilepsia 2007;48:77–81.
Dahlin MG, Beck OM, Amark PE. Plasma levels of antiepileptic drugs in children on the ketogenic diet. Pediatr Neurol 2006;35:6–10.
Coppola G, Verrotti A, D'Aniello A, et al. Valproic acid and phenobarbital blood levels during the first month of treatment with the ketogenic diet. Acta Neurol Scand 2010;122:303–307.
Heo G, Kim SH, Chang MJ. Effect of ketogenic diet and other dietary therapies on anti‐epileptic drug concentrations in patients with epilepsy. J Clinc Pharm Ther 2017;42:758–764.
Lyczkowski DA, Pfeifer HH, Ghosh S, et al. Safety and tolerability of the ketogenic diet in pediatric epilepsy: effects of valproate combination therapy. Epilepsia 2005;46:1533–1538.
Spilioti M, Pavlou E, Gogou M, et al. Valproate effect on ketosis in children under ketogenic diet. Eur J Paediatr Neurol 2016;20:555–559.
Coppola G, Epifanio G, Auricchio G, et al. Plasma free carnitine in epilepsy children, adolescents and young adults treated with old and new antiepileptic drugs with or without ketogenic diet. Brain Dev 2006;28:358–365.
McNally MA, Pyzik PL, Rubenstein JE, et al. Empiric use of oral potassium citrate reduces symptomatic kidney stone incidence with the ketogenic diet. Pediatrics 2009;124:e300–e304.
Huttenlocher P. Ketonemia and seizures: Metabolic and anticonvulsant effects of two ketogenic diets in childhood epilepsy. Pediatr Res 1976;10:536–540.
Lebel D, Morin C, Laberge M, et al. The carbohydrate and caloric content of concomitant medications for children with epilepsy on the ketogenic diet. Can J Neurol Sci 2001;28:322–340.
Kossoff EH, Pyzik PL, McGrogan JR, et al. Impact of early versus late anticonvulsant reduction after ketogenic diet initiation. Epilepsy Behav 2004;5:499–502.
Bergqvist AG, Chee CM, Lutchka L, et al. Selenium deficiency with cardiomyopathy: a complication of the ketogenic diet. Epilepsia 2003;44:618–620.
Bank IM, Shemie SD, Rosenblatt B, et al. Sudden cardiac death in association with the ketogenic diet. Pediatr Neurol 2008;39:429–431.
Sirikonda NS, Patten WD, Phillips JR, et al. Ketogenic diet: rapid onset of selenium deficiency‐induced cardiac decompensation. Pediatr Cardiol 2012;33:834–838.
Benn A, Swan CHJ, Cooke WT, et al. Effect of intraluminal pH on the absorption of pteroylmonoglutamic acid. British Med J 1971;1:148–150.
Lin A, Turner Z, Doerrer SC, et al. Complications during ketogenic diet initiation: prevalence, treatment, and influence on seizure outcomes. Pediatr Neurol 2017;68:35–39.
Kang HC, Chung DE, Kim DW, et al. Early and late‐onset complications of the ketogenic diet for intractable epilepsy. Epilepsia 2004;45:1116–1123.
Caraballo R, Vaccarezza M, Cersósimo R, et al. Long‐term follow‐up of the ketogenic diet for refractory epilepsy: multicenter Argentinean experience in 216 pediatric patients. Seizure 2011;20:640–645.
Kwiterovich PO Jr, Vining EP, Pyzik P, et al. Effect of a high‐fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA 2003;290:912–920.
Nizamuddin J, Turner Z, Rubenstein JE, et al. Management and risk factors for dyslipidemia with the ketogenic diet. J Child Neurol 2008;23:758–761.
Guzel O, Yılmaz U, Uysal U, et al. The effect of olive oil‐based ketogenic diet on serum lipid levels in epileptic children. Neurol Sci 2016;37:465–470.
Groesbeck DK, Bluml RM, Kossoff EH. Long‐term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol 2006;48:978–981.
Vining EP, Pyzik P, McGrogan J, et al. Growth of children on the ketogenic diet. Dev Med Child Neurol 2002;44:796–802.
Williams S, Basualdo‐Hammond C, Curtis R, et al. Growth retardation in children with epilepsy on the ketogenic diet: a retrospective chart review. J Am Diet Assoc 2002;102:405–407.
Peterson SJ, Tangney CC, Pimentel‐Zablah EM, et al. Changes in growth and seizure reduction in children on the ketogenic diet as a treatment for intractable epilepsy. J Am Diet Assoc 2005;105:718–725.
Kossoff EH, Pyzik PL, Furth SL, et al. Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet. Epilepsia 2002;43:1168–1171.
Sampath A, Kossoff EH, Furth SL, et al. Kidney stones and the ketogenic diet: risk factors and prevention. J Child Neurol 2007;22:375–378.
Furth SL, Casey JC, Pyzik PL, et al. Risk factors for urolithiasis in children on the ketogenic diet. Pediatric Nephrol 2000;15:125–128.
Guzin Y, Yılmaz U, Devrim F, Dincel N, Unalp A. Kidney Stones in Epileptic Children Receiving Ketogenic Diet: Frequency and Risk Factors. Neuropediatrics. 2023 Oct;54(5):308-314.
Best TH, Franz DN, Gilbert DL, et al. Cardiac complications in pediatric patients on the ketogenic diet. Neurology 2000;54:2328–2330.
Sharma S, Gulati S. The ketogenic diet and the QT interval. J Clin Neurosci 2012;18:181–182.
Stevens CE, Turner Z, Kossoff EH. Hepatic dysfunction as a complication of combined ketogenic diet and valproic acid. Pediatr Neurol 2016;54:82–84.
Ballaban‐Gil K, Callahan C, O'Dell C, et al. Complications of the ketogenic diet. Epilepsia 1998;39:744–748.
Kossoff EH, Laux LC, Blackford R, et al. When do seizures improve with the ketogenic diet? Epilepsia 2008;49:329–333.
Martinez CC, Pyzik PL, Kossoff EH. Discontinuing the ketogenic diet in seizure‐free children: recurrence and risk factors. Epilepsia 2007;48:187–190.
