How to Implement a Ketogenic Diet Therapy in Developing Countries: Colombian Consensus on Ketogenic Diet Therapy Use in the Management of Adults with Drug-Resistant Epilepsy

Background/Objectives: Drug-resistant epilepsy affects up to one-third of patients with epilepsy and is associated with higher morbidity, mortality, trauma events, psychosocial challenges, and decline in quality of life. In Latin America, disease burden is high and access to advanced therapies remains limited. Ketogenic Diet Therapy (KDT) has been shown to be beneficial in adults, but its implementation requires standardized protocols and experienced multidisciplinary teams. This study aimed to develop practical, evidence-based recommendations to guide the indication, implementation, and follow-up of KDT in adults with drug-resistant epilepsy through expert consensus in Colombia. Methods: A modified version of the Nominal Group Technique was used to develop, discuss, and vote on management concepts. Clinical questions were structured using the PICO framework. Literature searches were conducted in PubMed and EMBASE for articles published since 2015, and the evidence was integrated with the experience of a multidisciplinary expert panel. Results: Twelve recommendations were issued, covering commercial formulas, induction and follow-up protocols, individualized dietary interventions, safety, diagnostic support, nutritional supplementation, and drug-diet interactions. The consensus highlights the need for interdisciplinary teams, structured education, early adherence strategies, and close follow-up, and the role of enteral emergency formulas in intensive care settings. Conclusions: Evidence around KDT shows it can be implemented safely as an adjunctive treatment for adults with drug-resistant epilepsy and is reasonable to consider following the failure of two adequate antiseizure medications. Structured implementation may reduce seizure frequency, improve quality of life, and reduce the pharmacological burden. Multicenter prospective studies are needed to further assess efficacy, safety, and resource utilization. These recommendations contribute to closing the gap between evidence and clinical practice.