5 The KD is U0126 MAPK comprised mostly of fats, with low protein and low-as-possible glucose levels, combined with caloric and fluid intake restriction. In terms of weight, 1 gram of glucose and protein is added for every 3 and 4 grams of fat, respectively. The diet is intended to

replace glucose as the main energy source in the brain with ketone bodies, a product of fatty Inhibitors,research,lifescience,medical acid degradation. Studies have shown that the KD has the potential to decrease significantly the severity and number of seizures in epileptic children.1 However, the diet is difficult to maintain, and children often feel hungry, frustrated, and depressed. Any intake of cake or candy can lead to seizures. Thus, although parents generally prefer the diet over anti-epileptic drugs (AEDs), which have potential side effects, even the most enthusiastic ones may have trouble adhering to it, leading to a high attrition rate.1,6 The diet has been largely promoted by the Pediatric Neurology team of Johns Inhibitors,research,lifescience,medical Hopkins Hospital, headed by Dr JM Freeman, together with Drs EPG

Vining and E Kossoff and others.1,7,8 A systematic review of 26 published papers written on the use of KD in epileptic children concluded that there is evidence to support Inhibitors,research,lifescience,medical the cautious use of KDs in children with refractory epilepsy.3 We use the classic Johns Hopkins protocol at the Schneider Children’s Medical Center of Israel, a tertiary university-affiliated medical facility. This review discusses the indications and contraindications for the use of Inhibitors,research,lifescience,medical the KD, its effect on seizure number and severity, electroencephalographic (EEG) tracings, cognition and alertness levels, and its application in young infants with severe forms of epilepsy. The KD

has been used worldwide despite the Inhibitors,research,lifescience,medical occasional difficulties associated with it.9 There are some issues specific to Israel, as mentioned in Kossoff and McGrogan’s paper.9 The Israeli medical centers in Tel Hashomer and Holon had enrolled about 50 patients, and the authors described the issues uniquely relevant to their populations. Many families, especially Orthodox Jewish ones, are reluctant to use medications and are willing to try alternative Brefeldin_A measures if possible. They also need to contend with the caveat of consuming meat with milk products in order to observe the laws of kashrut. Thus, fish (with gills) and egg recipes can include heavy whipping cream, but those with meat must not. Bread used for religious purposes (e.g. challah as part of the Sabbath meal ritual and exclusive matzah consumption during Passover) is not suitable for a 4:1 ratio diet, while fruits, vegetables, and olive oil, which are plentiful and popular in Israel, are encouraged. Finally, if the father is a descendant from the priestly lineage (a “cohen”) and is therefore forbidden to enter a place that may hold dead bodies, the KD may have to be started on an outpatient basis, without a supervised fast.