The evolution of dietary therapy for neurologic disorders

In the 4 years since the first international symposium devoted to the ketogenic diet, held in Phoenix, Arizona, there has been a significant increase in research and interest in this unique therapy. Ketogenic diet centers have started in many countries throughout the world, including developing nations. Evidence for success using dietary treatment for adults has grown and led to adult epilepsy diet centers being formed in several academic institutions. The traditional ketogenic diet itself continues to evolve with now 4 unique diets (classic ketogenic, mediumchain triglyceride diet, modified Atkins diet, and low glycemic index treatment) as well as research leading to less restrictive, safer, and easier diets to use for all age ranges. What is perhaps most dramatic since the Phoenix meeting in 2008 has been the remarkable increase in interest among neurologists and physicians in the use of this metabolism-based therapy for conditions other than epilepsy. Research in the past 4 years has shown potential benefits of low-carbohydrate, highfat diets for diabetes, metabolic syndrome, Alzheimer disease, cancer, amyotrophic lateral sclerosis, to name a few. Specialists in these conditions often look to pediatric epileptologists familiar with the ketogenic diet for advice as they embark on clinical trials. Conversely, pediatric epileptologists are often reviewing the medical literature for advice on keeping patients healthy on low-carbohydrate diets, especially when long-term use is required. As a result, Drs Thiele and Thio and I, along with Beth Zupec-Kania and Jim Abrahams from the Charlie Foundation, as the 5 co-organizers of this Third Symposium on dietary therapy, thought it was the appropriate time for a unique conference. We wanted to make this conference different, bringing together experts from fields outside of epilepsy to share their knowledge and help create potential collaborations for the future. Now, as we publish this Special Issue detailing the proceedings of this spectacular conference, we believe we succeeded. This Special Issue will begin with the Thursday morning of the Symposium, chaired by Dr Adam Hartman, and focusing on the emerging neurologic, but nonepilepsy uses of dietary therapy including as well diabetic nephropathy and cancer. Before delving into these topics, Dr Helen Cross will discuss the highlights of the past 2 years regarding the ‘‘traditional’’ use of dietary therapies for epilepsy in children. Three multiauthor reviews will then cover the Thursday afternoon breakout sessions, devoted to nutritional aspects (Beth Zupec-Kania first author), basic mechanisms of action (Dr Liu Lin Thio), and the growing uses of diets for adults (Dr Mackenzie Cervenka). Friday morning’s lectures returned to the field of epilepsy, with presentations on Dravet syndrome, glucose 1 transporter deficiency, and status epilepticus. This Special Issue will then close with 2 final articles regarding the future implications of dietary therapies and a parent’s perspective on how to continue to make these exciting and helpful treatments more widely available. This meeting would not have been possible without the support of the Charlie Foundation as well as many sponsors including Nutricia, Chicago Sun-Times, Matthew’s Friends, Lundbeck, Vitaflo, Sigma-Tau, Epilepsy Therapy Project, Carson Harris Foundation, Athena, Atkins, Protocol for Life Balance, Epilepsy Cure Initiative, Solace Nutrition, Anita Kaufmann Foundation, Dravet Syndrome Foundation, Epilepsy Foundation Greater Chicago, Citizens United for Research in Epilepsy, Glucose Transporter 1 Deficiency Foundation, Intractable Childhood Epilepsy alliance, Lennox Gastaut Syndrome Foundation, Tuberous Sclerosis Alliance, Johns Hopkins Hospital, and LeBonheur Children’s Hospital. We also gratefully thank Gary Taubes and Matt Vanderheiden for their Wednesday evening keynote lectures. In addition, the inspirational speeches and involvement by Meryl Streep and Jeff Garlin at the Friday night gala reception helped bring this incredible meeting to an uplifting close. This Special Issue was supported and encouraged by Dr Roger Brumback, the EditorIn-Chief of the Journal of Child Neurology. Lastly, all of the organizers and speakers mourn the tragic loss of Dr Marwan Maalouf, the speaker on the topic of ketogenic diets and Alzheimer disease, who passed away shortly after this meeting. On behalf of the organizers and all the authors of these reviews, we hope you enjoy reading about this research as much as we valued hearing about it in Chicago. The ketogenic diet is certainly evolving, and this Special Issue demonstrates it. We are all excited to see where this evolution takes the diet over the next 2 years, leading up to the fourth international symposium in October 2014 in Liverpool, United Kingdom.