Immediate inpatient carbohydrate challenge: Novel method of ketogenic diet therapy discontinuation

Despite significant research into more flexible methods of ketogenic diet therapy initiation, there is only limited literature on the best practices to discontinue it. Both tradition and guidelines suggest weaning this treatment over 2-3 months; however, a more abrupt discontinuation has also been reported. Fifteen children and adults on ketogenic diet therapy, with various levels of seizure control, had their ketogenic diet therapy immediately discontinued. All were coincidentally admitted to inpatient units (typically an epilepsy monitoring unit), with intravenous access and electroencephalographic (EEG) monitoring. Patients and parents were counseled, regular foods or formula was ordered, and unlimited carbohydrates were provided to break ketosis under close supervision. Thirteen patients had no worsening in seizure frequency or EEG and were discharged home off of ketogenic diet therapy. Two patients, aged 4 and 33 years, had increased seizure frequency, and ketogenic diets were restarted prior to discharge. This method of safe, inpatient rapid diet discontinuation can be utilized as an alternative method to a more gradual weaning process.