The ketogenic diet began with the observation that starvation reduced seizures. Very early on, Hippocrates used starvation therapy to treat epilepsy, and Bible mentions starvation therapy as a method of epilepsy treatment. As early as the 1920s, Hugh Conklin, an American physician, used fasting without water to treat children with epilepsy and achieved a high success rate of treatment, with more patients being seizure-free for a long time. In 1921, Dr. Wilder of the Mayo Clinic first proposed a ketogenic diet (a high-fat, low-carbohydrate diet) that simulated the metabolic effects of starvation. In 1924, Dr. Peterman in the United States reported complete seizure control in 10 of 17 patients initially treated with this ketogenic diet, 9 of which were on the ketogenic diet alone. A new era of drug therapy for epilepsy began in 1939 with the introduction of the new antiepileptic drug phenytoin (dalantin), and the ketogenic diet was relatively complex and expensive compared to drugs. When phenobarbital as well as phenytoin sodium became effective in treating epilepsy, interest in diet therapy waned. Early 1990s: The beginning of a new era of ketogenic therapy was made possible by a Hollywood producer, DD Abraham, whose son Charlie had intractable epilepsy and spent $100,000 on multiple medications and other treatments that were ineffective, and was told by doctors that the patient’s prognosis was persistent seizures and progressive developmental decline. He then learned about the ketogenic diet therapy, went to John Hopkins Hospital and started the diet without medication, achieved complete seizure-free results, and adhered to the ketogenic diet for many years, able to go to school and live a normal, happy life. In order to make more parents aware of the ketogenic diet, Abraham created the Charlie Fund, published a monograph on the ketogenic diet, made a film on the ketogenic diet for patients and doctors, made a TV version of the film “The Harmless Way First”, and funded a study on the ketogenic diet involving 7 centers. 1996-present: The authors at Johns Hopkins Hospital report on 150 children with epilepsy treated with a ketogenic diet for 3, 6, and 12 months, and 3 to 6 years of follow-up. The results were dramatic. Since the 1920s, the efficacy results of the ketogenic diet reported for different age groups, different epilepsy frequencies, and different countries have been largely consistent. It is now internationally accepted that the newer antiepileptic pairs are only effective in 30-40% of children with refractory epilepsy (more than 50% reduction in seizures); whereas the ketogenic diet is effective in 50-80% of children with refractory epilepsy, with a 90% reduction in seizures in 30% of children and complete seizure control in 10-20% of patients. The usual age for receiving dietary therapy is 1-10 years, but trials for patients of other ages are not excluded. Ketogenic therapy is now more widely available worldwide, with approximately 80 centers in 45 countries offering ketogenic diet therapy.