Ketogenic diet for drug-resistant epilepsy
Ketogenic diet is an established treatment for children and adults whose epilepsy cannot be controlled with medications – one of the largest patient groups treated with the diet worldwide.
Epilepsy is one of the most common neurological diseases. About one in three people with epilepsy do not get sufficient effect from medications – this is called drug-resistant, or pharmacoresistant, epilepsy. For this group, ketogenic diet is an established and recognized treatment that has been in use for over 100 years.
The treatment is particularly well documented in children, but is also used in adults. The goal may be fewer seizures, milder seizures, reduced medication use or better quality of life. The effect varies between individuals, and some experience seizure freedom, while others get a significant but not complete improvement.
Ketogenic diet is not an alternative to medical follow-up, but a supplement that is planned and followed by a multidisciplinary specialist team. In Norway, the National Hospital for Epilepsy (SSE) at Oslo University Hospital has the national function for ketogenic diet.
Epilepsy syndromes where ketogenic diet is often considered
The overview is not exhaustive. Whether the diet is relevant is always assessed by a specialist in each individual case.
Dravet syndrome
Severe epilepsy disorder that begins in early childhood. Ketogenic diet is used as a supplement to medications to reduce seizure frequency.
Lennox-Gastaut syndrome
Epilepsy disorder with multiple seizure types and cognitive impairment. Ketogenic diet can be a useful addition in treatment resistance.
Myoclonic-astatic epilepsy (Doose)
Childhood epilepsy disorder where ketogenic diet can have good effect, especially early in the course.
Infantile spasms / West syndrome
Severe seizure syndrome in infants. Ketogenic diet is considered when there is lack of response to standard treatment.
Tuberous sclerosis
Genetic condition that often causes epilepsy. Ketogenic diet may be relevant for treatment-resistant seizures.
Other pharmacoresistant epilepsy
For seizures that cannot be controlled with two or more appropriate medications, ketogenic diet may be considered regardless of specific diagnosis.
Ketone bodies as alternative fuel for the brain
With a regular diet, glucose from carbohydrates is the brain's most important energy source. With ketogenic diet, carbohydrate intake is very low and fat intake is high, so the liver produces ketone bodies. These can cross the blood-brain barrier and be used as energy instead of glucose.
The exact mechanism behind the antiepileptic effect is not fully understood, but is thought to include stabilization of nerve cell membranes, altered neurotransmitter balance and reduced neuronal hyperexcitability. Regardless of mechanism, the effect is documented in numerous studies and recognized by international epilepsy communities.
A medical treatment
Close follow-up
Recognized treatment communities and sources
The professional content on this page is based on national and international guidelines and specialist communities.
OUS – National Hospital for Epilepsy (SSE): Ketogenic diet
SSE has the national function for ketogenic diet in Norway and treats children, youth and adults with drug-resistant epilepsy.
Helsebiblioteket – National guideline in pediatrics: Ketogenic diet
Clinical guideline recommending ketogenic diet as treatment for pharmacoresistant epilepsy and selected metabolic disorders.
Tidsskriftet.no – Diet treatment of epilepsy
Clinical overview (2017) of ketogenic diet as established treatment for pharmacoresistant epilepsy and metabolic disorders.
Ahus – Classic ketogenic diet for epilepsy
Patient-oriented information about ketogenic diet as treatment for epilepsy.
ILAE – Ketogenic diets (International League Against Epilepsy)
The world's leading epilepsy organization; collects international research and guidelines for ketogenic diet in epilepsy.
NICE – Epilepsies in children, young people and adults
British national guidelines that mention ketogenic diet as an option for drug-resistant epilepsy.