{ "abstract": "Background/Objectives: Drug-resistant epilepsy affects up to one-third of patients with epilepsy and is associated with higher morbidity, mortality, trauma events, psychosocial challenges, and decline in quality of life. In Latin America, disease burden is high and access to advanced therapies remains limited. Ketogenic Diet Therapy (KDT) has been shown to be beneficial in adults, but its implementation requires standardized protocols and experienced multidisciplinary teams. This study aimed to develop practical, evidence-based recommendations to guide the indication, implementation, and follow-up of KDT in adults with drug-resistant epilepsy through expert consensus in Colombia. Methods: A modified version of the Nominal Group Technique was used to develop, discuss, and vote on management concepts. Clinical questions were structured using the PICO framework. Literature searches were conducted in PubMed and EMBASE for articles published since 2015, and the evidence was integrated with the experience of a multidisciplinary expert panel. Results: Twelve recommendations were issued, covering commercial formulas, induction and follow-up protocols, individualized dietary interventions, safety, diagnostic support, nutritional supplementation, and drug-diet interactions. The consensus highlights the need for interdisciplinary teams, structured education, early adherence strategies, and close follow-up, and the role of enteral emergency formulas in intensive care settings. Conclusions: Evidence around KDT shows it can be implemented safely as an adjunctive treatment for adults with drug-resistant epilepsy and is reasonable to consider following the failure of two adequate antiseizure medications. Structured implementation may reduce seizure frequency, improve quality of life, and reduce the pharmacological burden. Multicenter prospective studies are needed to further assess efficacy, safety, and resource utilization. These recommendations contribute to closing the gap between evidence and clinical practice.", "abstract_shown": true, "affiliations": [ "Department of Neurology, Fundación Hospital Infantil Universitario de San José, Bogotá 111221, Colombia", "Neurology Program, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá 111411, Colombia", "Epilepsy Surgery Program, Neurocentro, Calle 12 #18-24 Torre 3 Piso 3, Pereira 660003, Colombia", "Epilepsy Program, CONEURO, Cúcuta 540003, Colombia", "Department of Neurology, Clínica FOSCAL-Fundación Oftalmológica-Centro Médico Carlos Ardila Lulle, Floridablanca 681004, Colombia", "Faculty of Medicine, Universidad de Antioquia UDA, Calle 70 No. 52-21, Medellín 050010, Colombia", "Neurology Section, Hospital Universitario San Vicente Fundación, Medellín 050010, Colombia", "Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA", "Epilepsy Program, Instituto Neurológico del Pacífico, Cali 760043, Colombia", "Neurology Section, Faculty of Medicine, Universidad del Valle, Cali 760032, Colombia", "Neurophysiology Unit, Neurocardiología del Caribe, Sincelejo 700001, Colombia", "Epilepsy and Epilepsy Surgery Service, Clínica Reina Sofía Colsanitas, Bogotá 110121, Colombia", "Faculty of Basic Sciences, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá 111411, Colombia", "Neurophysiology Unit, Clínica Medilaser, Neiva 410010, Colombia", "Neurophysiology Unit, Clínica Uros, Neiva 410010, Colombia", "Functional Neurology Section, Clínica CLAM, Bogotá 111111, Colombia", "Department of Neurology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia", "Faculty of Exact and Natural Health Sciences, Universidad Libre de Colombia, Pereira 660003, Colombia", "Fundación Fundem, Bogotá 110121, Colombia", "Clinical Nutrition, Asociación Médica de Cuidados Especiales (AMECE), Medellín 050021, Colombia", "Clinical Nutrition, Universidad Corporación en Estudio de la Salud (CES), Medellín 050021, Colombia", "Neurology Service, Hospital Militar Central, Bogotá 110231, Colombia", "Neurology and Neurophysiology Service, Mioneuro S.A.S., Ibagué 730006, Colombia", "Neurophysiology Service, Sociedad Médico Quirúrgica del Tolima, Ibagué 730006, Colombia", "Neurophysiology and Epilepsy, A.S. Neurophysiology Services, PLLC, Grand Rapids, MI 49525, USA" ], "article_type": "research article", "arxiv": null, "author_total": 16, "authors": [ { "affs": [ 0, 1 ], "name": "Jean Vergara-Aguilar", "orcid": "0000-0002-3154-2107" }, { "affs": [ 2, 3 ], "name": "Angélica Lizcano", "orcid": "0000-0002-0694-9423" }, { "affs": [ 4 ], "name": "Adriana Martinez-Perez", "orcid": "0000-0003-4033-6556" }, { "affs": [ 5, 6 ], "name": "Yamile Calle-López", "orcid": "0000-0002-7805-9200" }, { "affs": [ 7 ], "name": "Mackenzie Cervenka", "orcid": "0000-0002-4760-857X" }, { "affs": [ 8, 9 ], "name": "Carlos Clavijo-Prado", "orcid": "0000-0001-9486-8529" }, { "affs": [ 10 ], "name": "Juan Cotuá-Urzola", "orcid": "0000-0001-7383-5285" }, { "affs": [ 11 ], "name": "Walter González", "orcid": "0000-0003-0402-1960" }, { "affs": [ 12 ], "name": "Dahyana González-Velásquez", "orcid": "0009-0008-6223-8408" }, { "affs": [ 13, 14, 15 ], "name": "Malena Grillo-Ardila", "orcid": "0000-0003-4111-7582" }, { "affs": [ 16 ], "name": "Paula Martinez-Micolta", "orcid": "0000-0002-4654-4447" }, { "affs": [ 17, 18 ], "name": "Lina Ramírez", "orcid": "0009-0006-6247-8052" }, { "affs": [ 19, 20 ], "name": "Nataly Rincón-Franco", "orcid": "0000-0001-7615-5357" }, { "affs": [ 21 ], "name": "Juliana Osorio", "orcid": "0000-0002-6675-7431" }, { "affs": [ 22, 23 ], "name": "Lyda Villamil-Osorio", "orcid": "0009-0001-2532-6619" }, { "affs": [ 24 ], "name": "Adriana Tanner", "orcid": "0009-0005-5210-5263" } ], "bibtex": "https://research.draconitic.com/paper/8z2pj94x7yr79.bib", "cited_by": 0, "doi": "10.3390/nu18203458", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13708098/?tool=EBI", "id": "8z2pj94x7yr79", "issns": [ "2072-6643" ], "landing_url": "https://www.mdpi.com/2072-6643/18/20/3458", "language": "eng", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2737|Diet and metabolism studies" ] ], "openalex": "W7223176846", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13708098/pdf/?tool=EBI", "pmcid": "PMC13708098", "pmid": null, "published": "2026-10-01", "publisher": "MDPI AG", "ris": "https://research.draconitic.com/paper/8z2pj94x7yr79.ris", "sources": [ { "first_seen": "2026-10-30T12:19:56Z", "native_id": "10.3390/nu18203458", "source": "crossref", "url": "https://www.mdpi.com/2072-6643/18/20/3458" }, { "first_seen": "2026-10-30T12:21:25Z", "native_id": "PMC:PMC13708098", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13708098" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2737|Diet and metabolism studies", "subfield": "physiology" } ], "title": "How to Implement a Ketogenic Diet Therapy in Developing Countries: Colombian Consensus on Ketogenic Diet Therapy Use in the Management of Adults with Drug-Resistant Epilepsy", "title_text": "How to Implement a Ketogenic Diet Therapy in Developing Countries: Colombian Consensus on Ketogenic Diet Therapy Use in the Management of Adults with Drug-Resistant Epilepsy", "type": "peer-reviewed", "updated_at": "2026-10-30T12:21:25Z", "url": "https://research.draconitic.com/paper/8z2pj94x7yr79", "venue": "Nutrients", "versions": [] }