Introduction Ketogenic diet (KD) has been successfully used to treat seizures since early 1920s. Although less commonly used in later decades because of the increased availability of anticonvulsants, the KD has re-emerged as a therapeutic option in the early 90s. It is a high fat, low carbohydrate and adequate protein diet. The diet mimics the biochemical changes associated with starvation which creates ketosis. There are multiple likely mechanisms of action. Mitochondrial neuronal upregulation may likely be the common pathway, which explains the particular benefit of dietary therapies for mitochondrial disorders. Research has demonstrated that elevated free fatty acid (possibly polyunsaturated fatty acids) levels, ketosis (including acetoacetate, β-hydroxybutyrate, and acetone), caloric restriction, fasting, and reduced glucose may each be independently helpful for epilepsy.

Method Literature search was done using Cochrane Collaboration and evidence-based reviews.

Discussion The diet’s efficacy has been assessed in several studies and the efficacy is apparent. To date, there is a large clinical database of evidence on the efficacy of the KD available, including one randomised control trial published in 2008 (Neal et al., 2008). These studies suggest that up to 50% of children will experience at least 50% reduction in seizures on the KD; one third may achieve 90% seizure reduction and 10% will eventually become seizure-free and even medication free. More recently, studies have reported its use in refractory status epileticus. Nabbout et al.,2010 and Connor et al, November 2013 reported the successful use of the ketogenic diet to treat status epilepticus. However, it is a restrictive diet with side effects. Alternative more liberal varieties of the classical KD have been developed within the last 9 years. Clinical evidence suggests that these diet therapies have an efficacy close to the classical KD.

Conclusion KD has proven efficacy in childhood epilepsy. It is a radical medical therapy and nutritional well-being is a constant concern. Future research should focus on how best to provide dietary therapy and to whom, to ensure efficacy, safety and availability for children.