Ketogenic Diet: An Early Option for Epilepsy Treatment, Instead of A Last Choice Only

S ince 1921, a ketogenic diet (KD) of low-carbohydrate, adequate-protein, and high-fat content has been used for the treatment of intractable childhood epilepsy by achieving the antiepileptic effects of fasting.[1] Ancient records date back to the Middle Ages and even Biblical times when KD was achieved by fasting or as the so-called "water diet."[2] The KD was popular for treating epilepsy during the 1930s when few antiepileptics were available.After the discovery of phenytoin in 1938, many potent antiepileptics were found one after another and KD was abandoned gradually on account of its poor palatability and lack of placebo control studies primarily.It has been used continuously at several centers throughout the world in the USA and UK, but was not widely perceived as either effective or palatable for decades.Having resurged since 1994, KD was usually tried as a last resort in the treatment of intractable epilepsy after failure of many antiepileptics and even epilepsy surgery.Wang suggested that all patients should try KD before epilepsy surgery, including vagus nerve stimulation.[3]