[Ketogenic diet for intractable childhood epilepsy; as an early option as well as a last resort].

Since the 1920s, a ketogenic diet, of low-carbohydrate, adequate-protein and high-fat content, has been used for the treatment of intractable childhood epilepsy. A decade ago this diet was tried as a last resort in the treatment of intractable epilepsy. However, recent advances in ketogenic diet have enabled it to become more commonly used worldwide even early in the course of epilepsy. Two less-restrictive ketogenic diets, namely, the modified Atkins diet and low-glycemic-index treatment, have been developed. These diets allow the patients and their families to choose a more liberal menu. Furthermore, a randomized controlled trial found that the ketogenic diet has a significant benefit, which strengthens the supportive evidence. Recently, an international consensus statement guiding optimal clinical management has been published, allowing clinicians to provide standardized treatment. There has also been increased interest in investigating the mechanisms of action of ketogenic diet using various experimental models. The authors review the history, efficacy, side effects, and possible mechanisms underlying the ketogenic diet, as well as the experience with the ketogenic diet at Tokyo Women's Medical University.