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The ketogenic diet, named for the ketones excreted in the urine, is one of the oldest forms of therapy for epilepsy. It has fallen into disuse because of the availability of new and effective anticonvulsants. It is far easier to take several anticonvulsant pills each day than to adhere to this rigid and cumbersome diet. However, in situations where modern anticonvulsants are ineffective, or where their side effects are overwhelming, the ketogenic diet often can control seizures completely with few if any side effects on behavior and learning.

The beneficial effects of starvation and dehydration on seizures have been known for centuries. However, starvation and dehydration cannot be maintained over long periods of time. The ketogenic diet was developed to provide the minimal amount of protein necessary for growth, virtually no carbohydrates, and most of the required calories as fat. Numerous studies done in the 1930s found that the diet completely controlled seizures in almost 50 percent of children placed on the regimen and markedly improved seizure control in another 25 percent. However, in the late 1930s, with the introduction of phenytoin (Dilantin) and later other effective anticonvulsants, the ketogenic diet began to be used less frequently. Physicians then became less familiar with its use, and few dieticians were trained to utilize it properly. It is now used only in a few large centers.

At Johns Hopkins, where much of the early work on the diet was performed and where dieticians have continued to be familiar with its use, we have continued to use the diet fifteen or so times each year. A recent review of our results with children placed on the diet only as a last resort—severely handicapped children with frequent seizures refractory to all of the new anticonvulsants—shows that the diet completely controlled seizures in more than half of the cases. Thus, the diet continues to be a very useful form of therapy for properly selected individuals.

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