According to the Epilepsy Foundation, Epilepsy is the fourth most common neurological disorder and affects people of all ages. It is characterized by unpredictable seizures, can cause other health problems, and is a spectrum condition with a wide range of seizure types and control varying from person-to-person.

Despite a wide array of anti-epileptic drugs and the option of surgery, one-third of children and adults with epilepsy continue to suffer from drug-resistant seizures. Many of these patients may benefit from a ketogenic diet, a non-pharmacologic therapy proven to improve seizure control in epilepsy. Ketogenic diets aim to mimic the metabolic profile of fasting, and probably improve seizure control through a variety of mechanisms that collectively stabilize synaptic function. Although many similarities exist with regards to patient selection, patient preparation, and diet implementation in children compared to adults, there are also important differences. The most conspicuous challenge to the more widespread use of ketogenic diets in children and adults with epilepsy is a lack of access to ketogenic services in many regions of the world. Moreover, the culinary and social restrictions associated with conventional ketogenic diets pose a significant barrier to their use in adults.

In conclusion, ketogenic diets have been utilized as “end of the line” therapeutic options in children and adults with epilepsy. However, given recent advances in the possible mechanisms through which these diets improve seizure control and the growing evidence base supporting their use in epilepsy, this is changing. Significant challenges to the more widespread use of ketogenic diets in children and adults with epilepsy remain, most conspicuously a lack of access to ketogenic services in many regions of the world. Moreover, the culinary and social restrictions associated with conventional ketogenic diets are barriers to their use in adults. If these issues can be addressed, there may come a day when ketogenic diet therapies are utilized more widely, as first-line options alongside drugs and surgery, in the management of children and adults with epilepsy.

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