Ketogenic brownies for the last day at Pediatrics Neurology posting! For some kids with epilepsy the ketogenic diet is used as a treatment option – many of them achieving greater than 50% reduction in seizures. For seizure control it is actually a medical supervised option that may even require a short inpatient stay to titrate initially.

The way it works is likely multifactorial, but the general idea is that ketone bodies created in the liver from long and medium-chain fatty acids are directly anticonvulsant when crossing the blood-brain barrier. Some studies (mostly from the International Ketogenic Diet Study Group) have found that after six months, 60% of children started on the ketogenic diet had a greater than 50 percent seizure reduction, and 30 percent have greater than 90 percent seizure reduction. Kids must control their carbohydrates, but are allowed have very high fat and moderate protein in this diet. They can even supplement with MCT oils to increase the direct conversion of ketones.

At KKH there is a ketogenic diet clinic – where kids get put on a Modified Ketogenic diet that may be more friendly to follow, or the classical KD typically in the 4:1 ratio. There was this kid who was a huge fan of croquettes and Mayo – so she was already on the Keto diet, before her official KD diet initiation :p. In general these kids can still get to enjoy dishes such as horfun or soup noodles, as long as it is made with substitutions like Shirataki (konjac) noodles. Of course, this diet has its challenges. It should only be initiated by a proper specialist and clinical monitoring, including inpatient hospital stay. There was a child in the wards with epilepsy on the Ketogenic diet, whose medications was restricted to pill or IV only, as syrup medications contained too much carbohydrates. The team had to crush up the tablet to serve his medication.

For fun, here are the nutritional contents of these brownies and how it relates to Ketogenic diet: 1 serving 167 kcal / 2g net carb / 0g sugar / 16g fat / 5g protein. For kids I found this kind of cute!

Update 20 Feb 2022: Made these again and this time I used 170g powdered Erythritol (the original called for 200g). I also replaced half of the butter with vegetable oil. Texture was better but it was too sweet! Better to stick with the reduced sugar at 150g.