The efficacy of the ketogenic diet in 58 children with multiple seizure types resistant to antiepileptic drugs has been evaluated at the Johns Hopkins University School of Medicine, Baltimore. All patients had severe neurologic handicaps: mental retardation (84%), cerebral palsy (45%), and microcephaly (15%). Mean age at diet initiation was 60 months (range 12-235 months). EEGs showed Lennox-Gastaut pattern (33%), hypsarrhythmia (19%), and focal activity (14%). Antiepileptic drugs, including valproate, showed no adverse interaction. Seizures were completely controlled in 29%, and reduced by half in 38%. Diet was continued for an average of 24 months in those controlled and for 4 months in the unimproved group. Dietary benefit was not determined by seizure type. Renal stones required withdrawal of the diet in 2 patients. 
COMMENT. Despite further demonstration of its efficacy and relative safety, the ketogenic diet is not a popular method of therapy among neurologists generally. Apart from the Mayo Clinic and Johns Hopkins, the diet is not frequently promoted in the training of pediatric neurologists and dieticians. Furthermore, the bias against fat in the diet in today’s society adds to the difficulty in convincing mothers to become enthusiastic partners in the treatment program. Millichap JG at the Mayo Clinic  and Schwartz RM at the John Radcliffe Hospital, Oxford  studied the metabolic effects of the diet and were unable to document any significant changes in blood lipid profiles using the classical diet. For an account of the mechanism of action of the diet, see Millichap JG. Progress in Pediatric Neurology, Chicago, PNB Publ, 1991, p 87-88.