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October 2021; 11 (5) Research

International Recommendations for the Management of Adults Treated With Ketogenic Diet Therapies

Mackenzie C. Cervenka, Susan Wood, Manny Bagary, Antoaneta Balabanov, Eduard Bercovici, Mesha-Gay Brown, Orrin Devinsky, Cherubino Di Lorenzo, Colin P. Doherty, Elizabeth Felton, Laura A. Healy, Pavel Klein, Magnhild Kverneland, Danielle Lambrechts, Jennifer Langer, Janak Nathan, Jude Munn, Patty Nguyen, Matthew Phillips, Kelly Roehl, Adrianna Tanner, Clare Williams, Beth Zupec-Kania
First published October 30, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000001007
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Abstract

Objective To evaluate current clinical practices and evidence-based literature to establish preliminary recommendations for the management of adults using ketogenic diet therapies (KDTs).

Methods A 12-topic survey was distributed to international experts on KDTs in adults consisting of neurologists and dietitians at medical institutions providing KDTs to adults with epilepsy and other neurologic disorders. Panel survey responses were tabulated by the authors to determine the common and disparate practices between institutions and to compare these practices in adults with KDT recommendations in children and the medical literature. Recommendations are based on a combination of clinical evidence and expert opinion regarding management of KDTs.

Results Surveys were obtained from 20 medical institutions with >2,000 adult patients treated with KDTs for epilepsy or other neurologic disorders. Common side effects reported are similar to those observed in children, and recommendations for management are comparable with important distinctions, which are emphasized. Institutions differ with regard to recommended biochemical assessment, screening, monitoring, and concern for long-term side effects, and further investigation is warranted to determine the optimal clinical management. Differences also exist between screening and monitoring practices among adult and pediatric providers.

Conclusions KDTs may be safe and effective in treating adults with drug-resistant epilepsy, and there is emerging evidence supporting the use in other adult neurologic disorders and general medical conditions as well. Therefore, expert recommendations to guide optimal care are critical as well as further evidence-based investigation.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • ↵* These authors contributed equally to the manuscript.

  • Received November 14, 2019.
  • Accepted October 16, 2020.
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