%0 Journal Article
%T The Use of Ketogenic Diet in Pediatric Patients with Epilepsy
%A Amanda Misiewicz Runyon
%A Tsz-Yin So
%J ISRN Pediatrics
%D 2012
%R 10.5402/2012/263139
%X A ketogenic diet is a nonpharmacologic treatment strategy to control refractory epilepsy in children. Although this diet has been used successfully to reduce seizures since the 1920s, the anticonvulsant mechanism of ketosis remains unknown. The initiation of the diet requires an average four-day hospitalization to achieve ketosis in the patient as well as to provide thorough education on diet maintenance for both the patient and the caregivers. A ketogenic diet, consisting of low carbohydrate and high fat intake, leaves little room for additional carbohydrates supplied by medications. Patients on ketogenic diets who exceed their daily carbohydrate limit have the risk of seizure relapse, necessitating hospital readmission to repeat the diet initiation process. These patients are at a high risk for diversion from the diet. Patients admitted to the hospital setting are often initiated on multiple medications, and many hospital systems are not equipped with appropriate monitoring systems to prevent clinicians from introducing medications with high carbohydrate contents. Pharmacists have the resources and the expertise to help identify and prevent the initiation of medications with high carbohydrate content in patients on ketogenic diets. 1. Effect of Diet on Epilepsy A ketogenic diet is a strict diet consisting of minimal carbohydrate and protein intake and increased fat intake. It is used as a nonpharmacologic mechanism to control intractable childhood epilepsy [1]. Ketogenic diets mimic the body¡¯s response to starvation by using fat as the primary energy source in the absence of an adequate dietary carbohydrate source. Under normal metabolism, the body metabolizes carbohydrates into glucose, the fastest source of energy for the body and typically the sole energy source for the brain. In a fasting state, amino acids cannot provide an adequate energy source for the brain and fatty acids cannot cross the blood brain barrier. The liver uses the fatty acids to make ketone bodies, which can cross the blood brain barrier and substitute for glucose as an energy source. The mechanism of how ketosis controls seizures is unknown; however, one theory is that ketones have an anticonvulsant effect when crossing the blood brain barrier. Regardless of the mechanism, the effects of ketosis on seizure control have been observed since this diet was introduced in the 1920s [1]. 2. The Use and Effectiveness of Ketogenic Diets The primary indication for a ketogenic diet is intractable childhood epilepsy. The treatment is typically recommended when traditional antiepileptic
%U http://www.hindawi.com/journals/isrn.pediatrics/2012/263139/