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Peer-reviewedCC BY 4.0Nutrients

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

4 more authors
25 affiliations
  1. 1Department of Neurology, Fundación Hospital Infantil Universitario de San José, Bogotá 111221, Colombia
  2. 2Neurology Program, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá 111411, Colombia
  3. 3Epilepsy Surgery Program, Neurocentro, Calle 12 #18-24 Torre 3 Piso 3, Pereira 660003, Colombia
  4. 4Epilepsy Program, CONEURO, Cúcuta 540003, Colombia
  5. 5Department of Neurology, Clínica FOSCAL-Fundación Oftalmológica-Centro Médico Carlos Ardila Lulle, Floridablanca 681004, Colombia
  6. 6Faculty of Medicine, Universidad de Antioquia UDA, Calle 70 No. 52-21, Medellín 050010, Colombia
  7. 7Neurology Section, Hospital Universitario San Vicente Fundación, Medellín 050010, Colombia
  8. 8Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
  9. 9Epilepsy Program, Instituto Neurológico del Pacífico, Cali 760043, Colombia
  10. 10Neurology Section, Faculty of Medicine, Universidad del Valle, Cali 760032, Colombia
  11. 11Neurophysiology Unit, Neurocardiología del Caribe, Sincelejo 700001, Colombia
  12. 12Epilepsy and Epilepsy Surgery Service, Clínica Reina Sofía Colsanitas, Bogotá 110121, Colombia
  13. 13Faculty of Basic Sciences, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá 111411, Colombia
  14. 14Neurophysiology Unit, Clínica Medilaser, Neiva 410010, Colombia
  15. 15Neurophysiology Unit, Clínica Uros, Neiva 410010, Colombia
  16. 16Functional Neurology Section, Clínica CLAM, Bogotá 111111, Colombia
  17. 17Department of Neurology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia
  18. 18Faculty of Exact and Natural Health Sciences, Universidad Libre de Colombia, Pereira 660003, Colombia
  19. 19Fundación Fundem, Bogotá 110121, Colombia
  20. 20Clinical Nutrition, Asociación Médica de Cuidados Especiales (AMECE), Medellín 050021, Colombia
  21. 21Clinical Nutrition, Universidad Corporación en Estudio de la Salud (CES), Medellín 050021, Colombia
  22. 22Neurology Service, Hospital Militar Central, Bogotá 110231, Colombia
  23. 23Neurology and Neurophysiology Service, Mioneuro S.A.S., Ibagué 730006, Colombia
  24. 24Neurophysiology Service, Sociedad Médico Quirúrgica del Tolima, Ibagué 730006, Colombia
  25. 25Neurophysiology and Epilepsy, A.S. Neurophysiology Services, PLLC, Grand Rapids, MI 49525, USA

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.

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BibTeX
@article{vergaraaguilar2026implement,
  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}},
  author = {Jean Vergara-Aguilar and Angélica Lizcano and Adriana Martinez-Perez and Yamile Calle-López and Mackenzie Cervenka and Carlos Clavijo-Prado and Juan Cotuá-Urzola and Walter González and Dahyana González-Velásquez and Malena Grillo-Ardila and Paula Martinez-Micolta and Lina Ramírez and Nataly Rincón-Franco and Juliana Osorio and Lyda Villamil-Osorio and Adriana Tanner},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18203458},
  url = {https://www.mdpi.com/2072-6643/18/20/3458},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - 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
AU  - Jean Vergara-Aguilar
AU  - Angélica Lizcano
AU  - Adriana Martinez-Perez
AU  - Yamile Calle-López
AU  - Mackenzie Cervenka
AU  - Carlos Clavijo-Prado
AU  - Juan Cotuá-Urzola
AU  - Walter González
AU  - Dahyana González-Velásquez
AU  - Malena Grillo-Ardila
AU  - Paula Martinez-Micolta
AU  - Lina Ramírez
AU  - Nataly Rincón-Franco
AU  - Juliana Osorio
AU  - Lyda Villamil-Osorio
AU  - Adriana Tanner
PY  - 2026
DA  - 2026/10/01
JO  - Nutrients
DO  - 10.3390/nu18203458
UR  - https://www.mdpi.com/2072-6643/18/20/3458
AB  - 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.
SN  - 2072-6643
ER  -