Sometimes it's not just the decrease in seizures that is the benefit of the diet. Sometimes it may be the decrease in medicines. When dealing with the profoundly handicapped, tube-fed children who are further handicapped by seizures, switching to the ketogenic diet may be easy, requiring little effort by the family. It may be worth giving the diet a trial to see if the child (and family) will benefit.
Although seizure control is the aim of the diet, in 30 to 40 percent of children we do not achieve substantial control. However, other benefits of the diet include the ability to reduce medications and their toxicity. For some families these changes are sufficient reason to continue the diet. As always, the decision about the benefits and the hardships of a treatment remain with the family and the child.
We have not recommended the diet for children who have rare seizures. Often we are asked by parents of children with newly diagnosed epilepsy, "can't we go on the diet instead of using medications?" our answer has consistently been, "no. The diet is far more difficult than taking a few pills, and most seizures will easily respond to medication." we have reserved the diet for children whose seizures have failed to be controlled by two or more medications. Perhaps, when the diet is better studied, we may advocate its wider use in children less handicapped by seizures and medications.
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