Recently, renewed interest in using the ketogenic diets an alternative to current antiepileptic drugs has motivated the implementation of ketogenic diet programs across the U.S. This brief review provides a description of the diet and a critique of three key clinical studies done on the diet. Although the mechanisms of action of the diet are not fully understood, several hypotheses have been proposed. Early on, the diet's anticonvulsant effects were attributed to ketosis and acidosis but, more recently sodium/potassium balance, hyperlipidemia, and changes in nerve-lipid membranes and neurotransmitter function have been suggested as possible mechanisms, The diet provides the recommended daily allowance for protein, 80% to 90% of calories as fat, and an extremely small amount of carbohydrate, The ketogenic diet should be offered by a comprehensive team to children with intractable seizures and those who do not tolerate preferred antiepileptic drugs. The diet may be a cost-effective alternative to epilepsy surgery and an option to ''effective'' antiepileptic drugs in selected patients and families. Controlled prospective studies are dearly needed to establish the efficacy of the ketogenic diet.
