Dietary therapies in Lennox-Gastaut syndrome

Lennox-Gastaut Syndrome (LGS) is a severe developmental and epileptic encephalopathy of childhood characterized by drug-refractory epilepsy. Ketogenic diet (KD) therapies are non-pharmacologic adjuvant treatments that should be considered early in the course of the disease given challenges with pharmacoresistance and polytherapy. KD therapies are diets with high-fat and low-carbohydrates that induce ketotic metabolism with the goal of seizure control. KDs include classic ketogenic diet, medium-chain triglyceride diet (MCT), modified Atkins diet (MAD), and low glycemic index treatment (LGIT). Available evidence supports the efficacy of KD therapies in LGS with ≥50 % seizure reduction and seizure freedom in approximately 40-50 % of patients. KD therapies are considered safe and tolerable with close monitoring in LGS; however, side effects reported in the literature include diarrhea, constipation, emesis, and less frequently, osteopenia and nephrolithiasis. This review aims to provide a comprehensive overview of current dietary therapies with a particular focus on the efficacy and safety of these interventions in LGS.