Scientific rationale
- Therapeutic ketosis changes brain fuel availability and may influence neurotransmission, mitochondrial function, oxidative stress, inflammation, and seizure thresholds.
- Classical ketogenic, modified Atkins, MCT, and low glycaemic index approaches differ in restrictiveness, tolerability, and monitoring needs.
Research snapshot
- Guidelines and systematic reviews support considering ketogenic dietary therapies when appropriate antiseizure medicines have not provided adequate seizure control.
- The evidence base is strongest in paediatric epilepsy syndromes, but adult services increasingly use modified protocols when specialist support is available.
Clinical frame
- This belongs in a specialist pathway with dietetic education, medication review, laboratory monitoring, and a plan for side effects.
- Diet should not replace emergency seizure plans or clinician-led changes to antiseizure medication.
Open questions
- Which adults benefit most, and how can adherence be made realistic outside highly specialized centres?
- Can biomarkers predict seizure response, tolerability, and longer-term cardiometabolic effects?
Selected evidence
- Ketogenic diets for drug-resistant epilepsy Cochrane Database of Systematic Reviews, 2020
- Optimal clinical management of children receiving dietary therapies for epilepsy Epilepsia Open, 2018
- International recommendations for adults treated with ketogenic diet therapies Neurology Clinical Practice, 2021
- Classic ketogenic diet versus further antiseizure medicine in infants with drug-resistant epilepsy The Lancet Neurology, 2023
- Ketogenic diet therapy leads to antiseizure medication reduction in children and adults with drug-resistant epilepsy CNS Neuroscience & Therapeutics, 2024
- The ketogenic diet and potential micronutrient risks in drug-resistant epilepsy management Nutrients, 2026