The ketogenic diet was initially developed in the 1920s to mimic the metabolic effects of fasting for treating epilepsy. It has since shown benefits for a variety of metabolic, oncologic, neurodegenerative, and psychiatric disorders through mechanisms like improving mitochondrial function and ATP production. Common indications for the ketogenic diet include epilepsy, Parkinson's disease, Alzheimer's disease, cancer, traumatic brain injury, autism, and depression. Side effects can include low-level acidosis, constipation, and nutrient deficiencies.

2. 
 Ketogenic diet initially was developed in 1920 in
response to the observation that fasting had anti
seizure properties.
 Ketogenic diet can stimulate metabolic effects of
starvation.
 Ketogenc diet-High fat and low carbohydrate
Introduction

3. 
 It has beneficial effect on variety of metabolic,
Oncologic, neurodegenerative and psychatric
disorders with different mechanism of actions.
 It also has anti angiogenic effect
 Direct and Indirect effects (neurotransmission, ATP
production)

4. 
CLASS 1 CLASS 3
EPILEPSY PARKINSONS DISEASE
ALZHEIMER DISEASE AML
TRAUMATIC BRAIN INJURY
AUTISM
DEPRESSION
Indication

5. 
 Epilepsy-mutation in GLUT-1,PDH deficiency
DRAVERT SYNDROME: severe myoclonic epilepsy
febrile seizures
DOOSE SYNDROME: myoclonic astatic epilepsy
 Metabolic defects: PFK deficiency, McArdle
diease(glycogenolysis type V)
Indications

6. 
 Malignancy : Advanced astrocytoma,Gliomas
 Trauma and ischemia: fuel to injured brain and
cardio protective effects.
 Neurodegenerative diseases: PD,AD calorie
restriction itself is protective, ketogenic diet enhance
mitochondrial function, improvement in UPDRS

7. 
 Ketogenic diet protect against deposition of amyloid.
In AD high carb diet worsens the memory.
 Mitochondrial dysfunction is found to be the cause
of progression of ALS
 Autism: patients on modified Radcliffe diet shown
improvement in Childhood autism rating
scale(CARS)

8. 
 Depression: Ketogenic diet shown improvement in
Porsolt test and behavioural changes.
 Migraine , Headache and Narcolepsy

9. 
 In ketogenic diet body uses fat as primary source.
 Fat break down in liver-Ketones
 In neuronal tissue ketones are used in mitochondria
to generate ATP.
 Relation between urine ketones and seizure control
is imprecise .
Mechanism of action

10. 
 Enhancement of GABA function by ketone bodies
and increases the expression of GAD( 65 & 57)
 Saturated fatty acid and PUFA has neuro protective
effect. Arachidonic acid inhibit voltage gated sodium
channels.
 Brain metabolizes ketone better under conditions of
reduced glucose(calorie restriction)

11. 
DIRECT INDIRECT
KETONE BODIES
SUBSTRATE DELIVERY
ENHANCEMENT OF
MITOCHONDRIAL FUNCTION
ATP PRODUCTION
DECREASE ROS
NEUROTRANSMISSION
ION CHANNELS
MITOCHONDRIAL BIOGENISIS
Potential mediators

12. 
16
49
35
Protein
Carb
Fat
Standard diet

13. 
90
2
8
fat
Carb
Protein
Ketogenic Diet

14. 
646
30
Fat
Carb
Protein
Modified Atkins diet

15. 
Diet compostion Ketogenic diet Atkins Diet
Fat(% by weight) 80 60
Protein(% by weight) 15 30
Carbs 5 10
Calorie(% of DRA) 75 Not restricted

16. 
Typical ketogenic diets
Salad with walnuts Bluberry tart
Sausage and
cabbage dinner
with cream

17. 
Day prior to admission(Sunday):
Reduce carb for 24 hr on fasting from evening
Day 1(Monday)
On non carb fluids only, fasting continues till
dinner(1/3 rd of the calculated maintainance).
fluid restriction 60-75 cc/kg
BG Q6H, orange juice for glucose
John Hopkins Protocol

18. 
Day 2 (Tuesday)
Urine ketones periodically
Dinner increased to 2/3 rd. of maintenance.
Day 3 (Wednesday)
Breakfast and lunch given providing 2/3 rd of
maintainance
Dinner full Ketogenic meal

19. 
Day 4 (Thursday)
Full ketogenic diet breakfast
Education completed
Prescription for carb free diet
Child discharged

20. 
 Low level acidosis
 Lack of weight gain
 Constipation
 Diarrhoea and bloating
Side effects

21. 
 Significant dyslipidemia
 Kidney stones
 Hypoalbuminemia
 Pancreatitis
 Vitamin deficiencies
Less common

22. 
 After 2 years of seizure free or no improvement after
3- 6 months
 Dietary factors that worsen seizure:
1. Glutamate eg: MSG
2. Caffeine
3. Alcohol
4. betel nuts
5. Herbal remedies
Discontinuation

23. 

24. 
 59 year old male known case of Diabetes, CVA ,HTN
came with history of diplopia and blurring of vision.
 1 st episode of CVA on 2012 during that time he
presented with blurring of vision with pupil dilated
right eye and ptosis with left homonymous
hemianopia. With no EOM involvement.
 No limb weakness, DTR NORMAL.
Case presentation

25. 
 At that time provisional diagnosis was mid brain
stroke.
 The images MRI Brain showed

26. 

27. 

28. 

29. 
 On 2015 jan CVA with slurring of speech and right
facial palsy. At that time CT brain was took

30. 

31. 
 Patient presented with diplopia

32. 

33. 

34. 
SUMMARY

35. 
Final diagnosis:
 CVA-RIGHT OCCIPITAL ,LEFT
PARIETAL(MCA/PCA)
 RIGHT MEDIAL RECTUS PALSY
 PARTIAL 3RD NERVE PALSY (RIGHT SIDE)
 RIGHT FACIAL N UMN PALSY (RECOVERED)
 T2DM UNCONTROLLED (HBA1C :11)
 HTN