For patients with drug-refractory epilepsy, there are also dietary treatment options that have a clear therapeutic effect, such as the ketogenic diet. The ketogenic diet originated in ancient Greece when people did not understand the real cause of epilepsy and mistook it for evil possession, so they imprisoned epileptic patients. This led to the invention of a ketogenic diet that mimics the metabolic pattern of the body in a state of starvation, reducing carbohydrate and increasing fat intake so that the fat is metabolized in the liver to produce ketone bodies, which have an anticonvulsant effect and thus control seizures. The ketogenic diet has been used for the treatment of intractable epilepsy for nearly 100 years, and its efficiency has been recognized to be about 50% in children. Ketogenic diet classification: 1, classic ketogenic: ketogenic ratio 4:1, fat composition is mainly long-chain triglycerides, high ketone production, mainly used in infants and children, diet control is more strict. 2, medium-chain triglyceride diet: medium-chain triglyceride diet was used in children and adolescents, more likely to produce ketone bodies, but for some children can produce gastrointestinal irritation and vomiting, diarrhea, intestinal cramps. 3.Low glycemic index therapy: The ketogenic ratio is 0.6:1, which mainly relies on the intake of foods with glycemic index below 50, such as lentils, whole grain bread, processed oatmeal, olive oil, grapefruit, cucumber, etc., which can be chosen according to the recommended dietary varieties for diabetic patients. 4. Modified Atkins diet is an emerging diet therapy in recent years, which does not need to strictly restrict the amount of calories, proteins and liquids, and does not require precise weighing of food and adjustment of food ratios, and is easily tolerated by patients, but its efficacy is slightly inferior to that of the classical ketogenic diet, and it is generally recommended that patients, especially adult patients, can prefer the modified Atkins diet. Ketogenic diet treatment. Indications for the ketogenic diet: refractory epileptic seizure syndromes of various causes: infantile spasms, Lennox-Gastaut syndrome, Dravet syndrome, Doose syndrome, etc.; glucose carrier protein 1 (GLUT-1) deficiency, pyruvate dehydrogenase deficiency (PDHD). Contraindications to ketogenic diet: fatty acid oxidation and transport deficiency; pyruvate carboxylase deficiency; carnitine deficiency; impaired synthesis or breakdown of ketone bodies; mitochondrial disease; severe liver disease; diabetes, hypertension, hyperlipidemia, cardiovascular disease, peripheral vascular disease, etc. The ketogenic diet regimen requires at least one week of hospitalization to begin ketogenic diet therapy, and a professional dietitian will develop an individualized diet based on the patient’s When the diet is started, it is necessary to be alert to hypoglycemic reactions. After discharge from the hospital, it is necessary to regularly review the corresponding indicators, such as blood lipids, trace elements, electrolytes, etc. Each patient is usually required to adhere to the diet for at least 3 months, during which time the dietitian will make some fine adjustments according to the patient’s condition in order to achieve the most suitable diet for complete control of the attack. Patients can measure their blood ketone glucose regularly at home, or indirectly by measuring urine ketone levels. In some patients, diet therapy is effective within one week of initiation, and there have been cases of complete seizure-free cessation of drug therapy after diet therapy. A gradual transition to a regular diet can be made after two years of seizure freedom or one year of seizure freedom without antiepileptic drugs. If you stop the medication during the diet, you should follow your doctor’s instructions and not stop the medication on your own. Hypoglycemic reactions, often occurring at the beginning of the diet, may include lethargy, sweating, and panic. Gastrointestinal reactions (vomiting, bloating, diarrhea). Some patients give up on the ketogenic diet mostly because they cannot tolerate the gastrointestinal side effects. Some patients may develop hypercholesterolemia, which may return to normal at the end of the diet. Constipation, weight loss, fatigue, vitamin and mineral deficiencies are less common. Kidney stones are uncommon. Avoid concomitant use of drugs that are likely to complicate kidney stones, such as Toltea. Excessive ketosis, acidosis, and pancreatitis are rare. The ketogenic diet has many “grievances”. Many patients, including some doctors, are biased against the ketogenic diet and are afraid to try it because they do not have a proper understanding of it. Some people believe that ketosis is a bad phenomenon, stemming from a misunderstanding of diabetic ketoacidosis. In hunting times when our ancestors often could not eat for days because they could not find prey, the body would burn its own fat to provide energy to survive. The body can survive on stored glucose for only three days, while it can survive on stored fat for weeks. Patients treated with a ketogenic diet generally have blood ketone bodies that fluctuate between 3 and 5 mmol/L, and the body metabolizes the three major nutrients normally without acidosis. Ketosis coming from incompletely burned fat is not unhealthy. Some people believe that fat is not good and can lead to hyperlipidemia, atherosclerosis, and coronary heart disease, and many doctors have been emphasizing the need for patients to have a low-fat diet. However, one study found that patients on a ketogenic diet who ate a high-fat diet for more than two years did not have large fluctuations in blood lipid levels, and even if some patients experienced slight elevations in blood lipids, they returned to normal levels after stopping dietary treatment. Of course, adult patients with underlying diseases such as diabetes, hypertension, hyperlipidemia, and cardiovascular disease are not suitable for ketogenic diet therapy. There is also the belief that a high-fat diet can lead to obesity. A high-fat diet with restricted caloric intake will not increase weight. Many adults even choose high-fat diets to lose weight, and the modified Atkins diet evolved from this.