Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group


Eric H. Kossoff, Departments of Neurology and Pediatrics Johns Hopkins Outpatient Center Baltimore Maryland U.S.A.
Beth A. Zupec-Kania, The Charlie Foundation Santa Monica California U.S.A.
Stéphane Auvin, Department of Pediatric Neurology CHU Hôpital Robert Debré Paris France.
Karen R. Ballaban-Gil, Department of Neurology and Pediatrics Montefiore Medical Center/Albert Einstein College of Medicine Bronx New York U.S.A.
A G. Christina Bergqvist, Department of Neurology The Childrens Hospital of Philadelphia Philadelphia Pennsylvania U.S.A.
Robyn Blackford, Department of Nutrition Lurie Children's Hospital Chicago Illinois U.S.A.
Jeffrey R. Buchhalter, Department of Pediatrics Alberta Children's Hospital Calgary Alberta Canada.
Roberto H. Caraballo, Department of Neurology Hospital J P Garrahan, Capital Federal Buenos Aires Argentina.
J Helen Cross, Department of Clinical & Experimental Epilepsy Great Ormond Street Hospital University College London London United Kingdom.
Maria G. Dahlin, Department of Clinical Neuroscience, Women's and Children's Health Karolinska Institute Stockholm Sweden.
Elizabeth J. Donner, Division of Neurology The Hospital for Sick Children Toronto Ontario Canada.
Orkide Guzel, Department of Pediatric Neurology Izmir Dr. Behcet Uz Children's Hospital Izmir Turkey.
Rana S. Jehle, Department of Neurology Montefiore Medical Center Bronx New York U.S.A.
Joerg Klepper, Department of Pediatrics and Neuropediatrics Children's Hospital Aschaffenburg Aschaffenburg Germany.
Hoon-Chul Kang, Department of Pediatrics Pediatric Epilepsy Clinic Severance Children's Hospital Seoul Korea.
Danielle A. Lambrechts, Department of Neurology Epilepsy Centre Kempenhaeghe Heeze The Netherlands.
Y M. Liu, Department of Neurology The Hospital for Sick Children Toronto Ontario Canada.
Janak K. Nathan, Department of Child Neurology Shushrusha Hospital Mumbai India.
Douglas R. Nordli, Department of Neurology Children's Hospital of Los Angeles Los Angeles California U.S.A.
Heidi H. Pfeifer, Department of Neurology Massachusetts General Hospital Boston Massachusetts U.S.A.
Jong M. Rho, Department of Paediatrics Alberta Children's Hospital Calgary Alberta Canada.
Ingrid E. Scheffer, Epilepsy Research Centre The University of Melbourne Austin Health Heidelberg Victoria Australia.
Suvasini Sharma, Department of Pediatrics Lady Hardinge Medical College New Delhi India.
Carl E. Stafstrom, Departments of Pediatrics and Neurology Johns Hopkins Hospital Baltimore Maryland U.S.A.
Elizabeth A. Thiele, Department of Neurology Massachusetts General Hospital Boston Massachusetts U.S.A.
Zahava Turner, Department of Pediatrics The Johns Hopkins University Baltimore Maryland U.S.A.
Maria M. Vaccarezza, Department of Neurology Hospital Italiano de Buenos Aires Buenos Aires Argentina.
Elles J. van der Louw, Department of Dietetics Sophia Children's Hospital Erasmus Medical Centre Rotterdam The Netherlands.
Pierangelo Veggiotti, Infantile Neuropsychiatry Neurological Institute Foundation Casimiro Mondino Pavia Italy.
James W. Wheless, Department of Pediatric Neurology University of Tennessee Memphis Tennessee U.S.A.
Elaine C. Wirrell, Department of Neurology, Child and Adolescent Neurology Mayo Clinic Rochester Minnesota U.S.A.


Ketogenic dietary therapies (KDTs) are established, effective nonpharmacologic treatments for intractable childhood epilepsy. For many years KDTs were implemented differently throughout the world due to lack of consistent protocols. In 2009, an expert consensus guideline for the management of children on KDT was published, focusing on topics of patient selection, pre-KDT counseling and evaluation, diet choice and attributes, implementation, supplementation, follow-up, side events, and KDT discontinuation. It has been helpful in outlining a state-of-the-art protocol, standardizing KDT for multicenter clinical trials, and identifying areas of controversy and uncertainty for future research. Now one decade later, the organizers and authors of this guideline present a revised version with additional authors, in order to include recent research, especially regarding other dietary treatments, clarifying indications for use, side effects during initiation and ongoing use, value of supplements, and methods of KDT discontinuation. In addition, authors completed a survey of their institution's practices, which was compared to responses from the original consensus survey, to show trends in management over the last 10 years.

Publication Title

Epilepsia open