Ketogenic Diet Therapy; Improving Outcome, Management and New Indications

Ketogenic diet therapy (KDT) for epilepsy is a high-fat (71-90 energy% (en%)), low-carbohydrate (5-19 energy%) diet with adequate amounts of protein that mimics the metabolic state of fasting without caloric restriction. Although KDT nowadays is seen as a well-established and effective treatment option in pharmacoresistant epilepsy in children, evaluation of clinical practice shows that its management and outcomes might be further improved. For some vulnerable groups of patients, the feasibility and safety of KDT application needs to be explored. There are new insights from studies with animals that carbohydrate restriction might influence growth of malignant tumors, especially tumor types (e.g. malignant brain tumors) that highly depend on glucose as energy source.
The research presented in this thesis shows it is still not possible to predict successful outcome, that there is medication interfering efficacy of KDT, safe outpatient initiation of KDT is possible, consensus treatment guidelines for the vulnerable age group infants and one for parenteral application during complex medical situations. This thesis reports the application of KDT in new indications, during pregnancy of women with epilepsy and KDT as adjuvant to standard treatment of malignant brain tumors in both children and adults.
The outcomes of the studies presented in this thesis confirm the potential and importance of KDT from a medical, social and economic perspective and have the potency to stimulate management decisions on making this non-pharmacological treatment option more widely available. The use of KDT as metabolic therapy in oncology is a new exciting area that needs further exploration.