International consensus statement on clinical implementation of the ketogenic diet: Agreement, flexibility, and controversy

The ketogenic diet (KD) is an established, effective nonpharmacologic treatment for intractable childhood epilepsy. The KD is provided differently throughout the world, with occasionally significant variations in its administration. There exists a need for more standardized protocols and management recommendations for clinical and research use. In December 2006, the Charlie Foundation commissioned a panel comprised of 26 pediatric epileptologists and dietitians with particular expertise in using the KD. This group was convened to create a consensus statement regarding the clinical management of the KD; the consensus statement has also been endorsed by the Child Neurology Society. Members were asked to write sections based on clinical interests and the full document was subsequently reviewed and approved by the entire group. Recommendations were made regarding evaluation of children before starting the diet, specifically in regards to ideal patient selection, pre-KD counseling and testing, and choice of specific dietary therapy (ketogenic or less restrictive alternative diets). In addition, there was information provided regarding diet implementation (need for fasting and admission), supplementation, follow-up management (frequency of visits as well as diet and laboratory evaluations while receiving the diet), adverse event monitoring, and timing and method of eventual KD discontinuation. This group effort highlights recommendations based on best evidence, including areas of agreement and controversy, unanswered questions, and future research.