Régime cétogène dans les épilepsies de l'enfant

The ketogenic diet (KD) is as an established treatment for epilepsy, particularly in pharmaco-resistant epilepsy. The KD is also frequently used in some pediatric syndrome, as the infantile spasm, epilepsy with myoclono-atonic seizure. The KD is a high-fat, low-protein and low-carbohydrate diet. More recently, other ketogenic diets have been developed and positively evaluated such as modified Atkins diet. In most of the case, the KD is used as an add-on treatment but it has been reported to be used as a first line treatment. Its efficacy is proved by many studies including two randomized trials. The efficacy of the KD is greater than 50 % reduction in seizure frequency for about half of patients at 3 months under diet and a decrease of more than 90 % of epileptic seizures for one per ten to twenty patients. In most cases, the diet is initiated during hospitalization. It is a stringent diet and we need a good parental and child adhesion. Like any treatment, the diet could have adverse effects. A good knowledge is helpful for an early identification. Here, we reviewed the possible mechanisms of actions of the KD, the data on efficacy and safety, its indication and contraindication and how to conduct the monitoring of a patient under dietary treatment.