Researchers at Medical University Vienna, Austria, report the efficacy and safety of the ketogenic diet (KD) in treatment of epilepsy in a 3-year 6 month-old girl with diabetes type 1 followed for 15 months. Right-sided spastic hemiparesis with widespread left hemisphere malformation were diagnosed at 9 months and were associated with focal tonic seizures during sleep. EEG-video monitoring showed interictal spikes in left central-parietal, and frontal and occipital electrodes. Seizure frequency (1-2 per week) increased at 30 months of age and because of side effects, the parents stopped antiepileptic drug treatment but agreed to a trial of the KD. John Hopkins’ KD protocol was followed with a 2.5:1 ratio, and insulin requirement was reduced. Since the KD, no clinical seizures were reported but after 10 months, the EEG showed persistent epileptiform activity over the left hemisphere and 4 subclinical seizures, especially during sleep. Gains in language and motor skills were observed. No severe hypoglycemia or ketoacidosis occurred and metabolic control was maintained. The child refused ketogenic meals and the parents discontinued the diet after 15 months, and no clinically overt seizures were reported. 
COMMENT. The authors conclude that diabetes does not preclude the use of the ketogenic diet in treatment of childhood epilepsy. Glycemic control is maintained without severe side effects, and development may be improved.