Neurology

 

Healthcare Professional Tools

  • KetoCal Pocket Portfolio

    KetoCal, Liquigen and Polycal product information including, nutrition information and approximate household measures.

  • KetoCal Blenderized Diet Recipes

    Blenderized diet recipes using real food with KetoCal and Liquigen. Three keto Dietitians, Lindsey, Laura and Jessica share their favorite blenderized keto recipes to inspire you.

  • KetoCal Authorization Form

    Due to the medical food status, consent from a healthcare provider is required for patients/caregivers to purchase or obtain a sample of any KetoCal products directly through Nutricia. As a healthcare provider, you can provide consent for your patient online at MyKetoCal.com or by completing this form.

  • KetoCal DRI Calculator

    Compare nutrients for a chosen amount of any KetoCal product to the Dietary Reference Intakes (DRIs) for any group. Adjust the calorie level by changing the calories in the green box at the top of the Excel sheet.

  • KetoCal Patient Starter Kit

    We are pleased to offer New Patient Starter Kits to help your patients start and stay on the medical ketogenic diet successfully. Each kit contains a digital gram scale, cooking spatula, mixing bowl, caregiver guide, and more. If you’d like to have starter kits or instruction postcards on hand for your clinic, please reach out to your Nutricia Territory Manager.

  • Nutricia Navigator

    A free service to help your patients obtain insurance coverage and faster access to Nutricia products. Find 3 easy steps to get started.

  • Ketogenic Diet for Adults – References

    This document provides a list of references supporting the use of the ketogenic diet for intractable in adults.

  • Letters of Medical Necessity

    We created the following sample letters of medical necessity to help patients request insurance coverage for KetoCal or Liquigen. You can complete the missing information and individualize the letters to suit your patient's situation and needs. Simply click the appropriate product below to download the Word file of each sample letter. Please note: our Nutricia Product Coverage Navigator team is available to help you and your patients to obtain coverage for our medical foods. This includes assistance with drafting letters of medical necessity, obtaining prior authorization for our products, correcting billing errors, appealing denied claims and much more. If you or your patients need personalized assistance with KetoCal or Liquigen coverage call 1-800-365-7354 or email NutriciaNavigator@nutricia.com

Flowcharts/Guidelines

  • KetoCal Tube Feeding Guidelines

    The guidelines cover the transition and monitoring of the medical ketogenic diet by tube during initiation, maintenance and discontinuation of the diet.

  • KetoCal Clinician Decision Guide

    This guide illustrates the most appropriate and convenient choice of ketogenic formula for various types of ketogenic diet. It is a tool that may be used as a decision making guide for clinicians. The flowchart poses guiding questions and considerations to ensure patients nutrition needs are being met. It includes a list of the KetoCal family of products.

  • Green Flags for the Using the Ketogenic Diet in Refractory Epilepsy

    This document helps neurologists or other healthcare professionals to identify ideal patient candidates for the ketogenic diet.

Reference Library

  • Publications & Guidelines Known to Use KetoCal

    References Available:

    • 1. Hallböök T, Kohler S, Rosen I, et al. Effects of ketogenic diet on epileptiform activity in children with therapy resistant epilepsy. Epilepsy Res. 2007;77(2-3):134-40. PubMed
    • 2. Rubenstein JE. Use of the ketogenic diet in neonates and infants. Epilepsia. 2008;49(s8):30-2. PubMed
    • 3. Kossoff EH, Hedderick EF, Turner Z, et al. A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms. Epilepsia. 2008;49(9):1504-9. PubMed
    • 4. Hong AM, Turner Z, Hamdy RF, et al. Infantile spasms treated with the ketogenic diet: Prospective single-centerexperience in 104 consecutive infants. Epilepsia. 2010;51(8):1403-7. PubMed
    • 5. Nabbout R, Mazzuca M, Hubert P, et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children(FIRES). Epilepsia. 2010;51(10):2033-7. PubMed
    • 6. Coppola G, Verrotti A, Ammendola E, et al. Ketogenic diet for the treatment of catastrophic epileptic encephalopathies in childhood. Eur J Paediatr Neurol. 2010;14(3):229-34. PubMed
    • 7. Wusthoff CJ, Kranick SM, Morley JF, et al. The ketogenic diet in treatment of two adults with prolonged nonconvulsive status epilepticus. Epilepsia. 2010;51(6):1083-5. PubMed
    • 8. Urbizu A, Cuenca-Leon E, Raspall-Chaure M, et al. Paroxysmal exercise-induced dyskinesia, writer's cramp, migraine with aura and absence epilepsy in twin brothers with a novel SLC2A1 missense mutation. J Neurol Sci. 2010;295:110-3. PedMed
    • 9. Zupec-Kania B. Enteral and Parenteral Applications of Ketogenic Diet Therapy: Experiences From Four Centers. ICAN: Infant, Child, & Adolescent Nutrition. 2011;3:274-81. PubMed
    • 10. Cervenka MC, Hartman AL, Venkatesan A, et al. The ketogenic diet for medically and surgically refractory status epilepticus in the neurocritical care unit. Neurocrit Care. 2011;15(3):519-24. PubMed
    • 11. Roan M. Management of Long-Term Ketogenic Parenteral Nutrition. ICAN: Infant, Child, & Adolescent Nutrition. 2011;3:282-7. Sagepub
    • 12. Kossoff EH, Dorward JL, Turner Z, et al. Prospective study of the modified atkins diet in combination with a ketogenic liquid supplement during the initial month. J Child Neurol. 2011;26(2):147-51. PubMed
    • 13. Christodoulides SS, Neal EG, Fitzsimmons G, et al. The effect of the classical and medium chain triglyceride ketogenic diet on vitamin and mineral levels. J Hum Nutr Diet. 2012;25(1):16-26. PubMed
    • 14. Cusmai. Ketogenic diet in early myoclonic encephalopathy due to non ketotic hyperglycinemia. Eur J Paediatr Neurol. 2012;16:509-13. PubMed
    • 15. Suo C, Liao J, Lu X, et al. Efficacy and safety of the ketogenic diet in Chinese children. Seizure. 2013;22(3):174-8. PubMed
    • 16. El-Rashidy OF. Modified Atkins diet vs classic ketogenic formula in intractable epilepsy. Acta Neurol Scand. 2013;128(6):402-8. PubMed
    • 17. Sort R, Born AP, Pedersen KN, et al. Ketogenic diet in 3 cases of childhood refractory status epilepticus. Eur J Paediatr Neurol. 2013;17(6):531-6. PubMed
    • 18. Kossoff EH, Henry BJ, Cervenka MC. Efficacy of dietary therapy for juvenile myoclonic epilepsy. Epilepsy Behav. 2013;26(2):162-4. PubMed
    • 19. Strzelczyk A, Reif PS, Bauer S, et al. Intravenous initiation and maintenance of ketogenic diet: proof of concept in super-refractory status epilepticus. Seizure. 2013;22(7):581-3. PubMed
    • 20. Pires M. Ketogenic diet for infantile spasms refractory to first-line treatments: An open prospective study. Epilepsy Research. 2013;13:S0920-1211. PubMed
    • 21. Caraballo RH, Flesler S, Armeno M, et al. Ketogenic diet in pediatric patients with refractory focal status epilepticus. Epilepsy Res. 2014;108(10):1912-6. PubMed
    • 22. Groveman SA. Ketogenic Diet Patients' Lipid Profiles Improved with KetoCal 4:1 Liquid: A Case Series. ICAN Infant Child Adolesc Nutr. 2015;7(3):157-161. Sagepub
    • 23. Dressler A, Trimmel-Schwahofer P, Reithofer E, et al. Efficacy and tolerability of the ketogenic diet in Dravet syndrome - Comparison with various standard antiepileptic drug regimen. Epilepsy Res. 2015; 109:81-9. PubMed
    • 24. Dressler A, Trimmel-Schwahofer P, Reithofer E, et al. The ketogenic diet in infants - Advantages of early use. Epilepsy Res. 2015; 116:53-8. PubMed
    • 25. van der Louw E, van den Hurk D, Neal E, et al. Ketogenic diet guidelines for infants with refractory epilepsy. Eur J Paediatr Neurol. 2016. PubMed
    • 26. Ashrafi MR, Hosseini SA, Zamani GR, et al. The efficacy of the ketogenic diet in infants and young children with refractory epilepsies using a formula-based powder. Acta Neurol Belg. 2017; 117:175-82. PubMed
    • 27. Sampaio LPB, Takakura C, Manreza MLG. The use of a formula-based ketogenic diet in children with refractory epilepsy. Arq Neuropsiquiatr. 2017; 75:234-7. PubMed
    • 28. Weijenberg A, van Rijn M, Callenbach PMC, et al. Ketogenic Diet in Refractory Childhood Epilepsy: Starting with a Liquid Formulation in an Outpatient Setting. Child Neurol Open. 2018; 5:2329048. PubMed
    • 29. McDonald TJW, Henry-Barron BJ, Felton EA, et al. Improving compliance in adults with epilepsy on a modified Atkins diet: A randomized trial. Seizure. 2018; 60:132-8. PubMed
    • 30. Karimzadeh P, Moosavian T, Moosavian HR. Effects of a Formula-Based Ketogenic Diet on Refractory Epilepsy in 1 to 3 Year-Old Patients under Classic Ketogenic Diet. Iran J Child Neurol. 2019;13:83-90. PubMed
  • The Ketogenic Diet for Children with Intractable Epilepsy

    Clinical References for The Ketogenic Diet for Children with Intractable Epilepsy.

    • Aguirre Castaneda RL, et al. Successful treatment of type 1 diabetes and seizures with combined ketogenic diet and insulin. Pediatrics. 2012 Feb;129(2):e511-4. PubMed
    • Cusmai R, et al. Ketogenic diet in early myoclonic encephalopathy due to non ketotic hyperglycinemia. Eur J Paediatr Neurol. 2012 Jan 17. [Epub ahead of print] PubMed
    • Groomes LB, et al. Do patients with absence epilepsy respond to ketogenic diets? J Child Neurol. 2011 Feb;26(2):160-5. PubMed
    • Dressler A, et al. Long-term outcome and tolerability of the ketogenic diet in drug-resistant childhood epilepsy--the Austrian experience. Seizure. 2010 Sep;19(7):404-8. PubMed
    • Patel A, et al. Long-term outcomes of children treated with the ketogenic diet in the past. Epilepsia. 2010 Jul;51(7):1277-82. PubMed
    • Kossoff EH. The ketogenic diet: an appropriate first-line therapy? Expert Rev Neurother. 2010 Jun;10(6):843-5. PubMed
    • Coppola G, et al. Ketogenic diet for the treatment of catastrophic epileptic encephalopathies in childhood. Eur J Paediatr Neurol. 2010 May;14(3):229-34. PubMed
    • Kossoff EH, et al. Ketogenic Diets: An Update for Child Neurologists. J Child Neurol. 2009 Aug;24(8):979-88. PubMed
    • Neal EG, et al. A randomized trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia. 2009;50(5):1109–17. PubMed
    • Rubenstein JE. Use of the ketogenic diet in neonates and infants. Epilepsia. 2008 Nov;49 Suppl 8:30-2. PubMed
    • Kossoff EH, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304-17. PubMed
    • Freeman JM, et al. The ketogenic diet: one decade later. Pediatrics. 2007 Mar;119(3):535-43. Abstract
    • Bergqvist AG, et al. Vitamin D status in children with intractable epilepsy, and impact of the ketogenic diet. Epilepsia. 2007 Jan;48(1):66-71. PubMed
    • Hartman AL, et al. Clinical aspects of the ketogenic diet. Epilepsia. 2007 Jan;48(1):31-42. Abstract
    • Bough KJ, et al. Anticonvulsant mechanisms of the ketogenic diet. Epilepsia. 2007 Jan;48(1):43-58. PubMed
    • Groesbeck DK, et al. Long-term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol. 2006 Dec;48(12):978-81. PubMed
    • Henderson CB, et al. Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis. J Child Neurol. 2006 Mar;21(3):193-8. PubMed
    • Bergqvist AG, et al. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia. 2005 Nov;46(11):1810-9. PubMed
    • Rubenstein JE, et al. Experience in the use of the ketogenic diet as early therapy. J Child Neurol. 2005 Jan;20(1):31-4. PubMed
    • Pfeifer HH, et al. Low-glycemic-index treatment: a liberalized ketogenic diet for treatment of intractable epilepsy. Neurology. 2005 Dec 13;65(11):1810-2. PubMed
    • Kossoff EH, et al. Benefits of an all-liquid ketogenic diet. Epilepsia. 2004 Sep;45(9):1163. PubMed
    • Mandel A, et al. Medical costs are reduced when children with intractable epilepsy are successfully treated with the ketogenic diet. J Am Diet Assoc. 2002 Mar;102(3):396-8. PubMed
    • Hemingway C, et al. The ketogenic diet: a 3- to 6-year follow-up of 150 children enrolled prospectively. Pediatrics. 2001 Oct;108(4):898-905. PubMed
    • Freeman JM, et al. The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358-63. PubMed
  • The Modified Atkins Diet for Children with Intractable Epilepsy

    Clinical References for The Modified Atkins Diet for Children with Intractable Epilepsy.

    • Sharma S, et al. Use of the modified Atkins diet in infantile spasms refractory to first-line treatment. Seizure. 2012 Jan;21(1):45-8. PubMed
    • Kim YM, et al. Various indications for a modified Atkins diet in intractable childhood epilepsy. Brain Dev. 2011 Oct 14. PubMed
    • Kossoff EH, et al. Prospective study of the Modified Atkins Diet in combination with a ketogenic liquid supplement during the initial month. J Child Neurol 2011;26(2):147-51. PubMed
    • Ito Y, et al. A modified Atkins diet is promising as a treatment for glucose transporter type 1 deficiency syndrome. Dev Med Child Neurol. 2011 Jul;53(7):658-63. PubMed
    • Miranda MJ, et al. Danish study of a Modified Atkins diet for medically intractable epilepsy in children: Can we achieve the same results as with the classical ketogenic diet? Seizure. 2011;20:151-155. PubMed
    • Kumada T, et al. Modified Atkins Diet for the Treatment of Nonconvulsive Status Epilepticus in Children. J Child Neurol. 2010;25(4):485-489. PubMed
    • Kossoff EH, at al. A pilot study of the modified Atkins diet for Sturge-Weber syndrome. Epilepsy Res. 2010 Dec;92(2-3):240-3. PubMed
    • Barzegar M, et al. A Modified Atkins Diet for Intractable Epilepsy. Iran J Child Neurology. 2010;4(3):15-20. Abstract
    • Tonekaboni SH, et al. Efficacy of the Atkins diet as therapy for intractable epilepsy in children. Archives of Iranian Medicine. 2010;13(6):492-7. PubMed
    • Porta N, et al. Comparison of seizure reduction and serum fatty acid levels after receiving the ketogenic and modified Atkins diet. Seizure. 2009;18(5):359–364. PubMed
    • Kang HC, et al. Use of a modified Atkins diet in intractable childhood epilepsy. Epilepsia. 2007;48(1):182–6. PubMed
    • Kossoff EH, et al. A randomized, crossover comparison of daily carbohydrate limits using the modified Atkins diet. Epilepsy Behav. 2007 May;10(3):432-6. PubMed
    • Kossoff EH, et al. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia. 2006;47(2):421-4. PubMed
  • Dietary Therapies for Adults with Epilepsy

    Clinical References for Dietary Therapies for Adults with Epilepsy

    • Wusthoff CJ, et al. The ketogenic diet in treatment of two adults with prolonged nonconvulsive status epilepticus. Epilepsia. 2010 Jun;51(6):1083-5. PubMed
  • Infantile Spasms

    Clinical References for Infantile Spasms.

    • Sharma S, et al Use of the modified Atkins diet in infantile spasms refractory to first-line treatment. Seizure. 2012 Jan;21(1):45-8. PubMed
    • Numis AL, et al. The relationship of ketosis and growth to the efficacy of the ketogenic diet in infantile spasms. Epilepsy Res. 2011 Jun 21. PubMed
    • Hong AM, et al. Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants. Epilepsia. 2010 Aug;51(8):1403-7. PubMed
    • Kossoff EH, et al. A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms. Epilepsia. 2008 Sep;49(9):1504-9. PubMed
    • Eun SH, et al. Ketogenic diet for treatment of infantile spasms. Brain Dev. 2006 Oct;28(9):566-71. PubMed
    • Kossoff EH, et al. Efficacy of the ketogenic diet for infantile spasms. Pediatrics. 2002 May;109(5):780-3. PubMed
  • Glut1 Deficiency Syndrome

    Clinical References for Glut1 Deficiency Syndrome.

    • Ito Y, et al. A modified Atkins diet is promising as a treatment for glucose transporter type 1 deficiency syndrome. Dev Med Child Neurol. 2011 Jul;53(7):658-63. PubMed
    • Klepper J. Glucose transporter deficiency syndrome (GLUT1DS) and the ketogenic diet. Epilepsia. 2008 Nov;49 Suppl 8:46-9. PubMed
    • Cornejo VE, et al. Glucose transponer type 1 deficiency síndrome (GLUT-1 SD) treated with ketogenic diet. Report of one case. Rev Med Chil. 2007 May;135(5):631-5. PubMed
  • Dravet Syndrome

    Clinical References for Dravet Syndrome

    • Nabbout R, et al. Ketogenic diet also benefits Dravet syndrome patients receiving stiripentol: A prospective pilot study. Epilepsia. 2011 Jul;52(7):e54-7. PubMed
    • Veggiotti P, et al. The ketogenic diet for Dravet syndrome and other epileptic encephalopathies: an Italian consensus. Epilepsia. 2011 Apr;52 Suppl 2:83-9. PubMed
    • Caraballo RH. Nonpharmacologic treatments of Dravet syndrome: focus on the ketogenic diet. Epilepsia. 2011 Apr;52 Suppl 2:79-82. PubMed
    • Caraballo RH, et al. Ketogenic diet in patients with Dravet syndrome. Epilepsia. 2005 Sep;46(9):1539-44. PubMed
  • Myoclonic Astatic Epilepsy (also known as Doose Syndrome)

    Clinical References for Myoclonic Astatic Epilepsy (also known as Doose Syndrome).

    • Mulligan JE, et al. Myoclonic astatic epilepsy and the role of the ketogenic diet. Med Health R I. 2011 May;94(5):127-30. PubMed
    • Kossoff EH, et al. Will seizure control improve by switching from the modified Atkins diet to the traditional ketogenic diet? Epilepsia. 2010 Dec;51(12):2496-9. PubMed
    • Caraballo RH, et al. Ketogenic diet in patients with myoclonic-astatic epilepsy. Epileptic Disord. 2006 Jun;8(2):151-5. PubMed
  • Sturge-Weber Syndrome

    Clinical References for Sturge-Weber Syndrome.

    • Kossoff EH, et al. A pilot study of the modified Atkins diet for Sturge-Weber syndrome. Epilepsy Res. 2010 Dec;92(2-3):240-3. PubMed
  • Tuberous Sclerosis

    Clinical References for Tuberous Sclerosis.

    • Coppola G, et al.The effects of the ketogenic diet in refractory partial seizures with reference to tuberous sclerosis. Eur J Paediatr Neurol. 2006 May;10(3):148-51. Epub 2006 Apr 24. PubMed
    • Kossoff EH, et al. Tuberous sclerosis complex and the ketogenic diet. Epilepsia. 2005 Oct;46(10):1684-6. PubMed
  • Pyruvate Dehydrogenase Deficiency

    Clinical References for Pyruvate Dehydrogenase Deficiency.

    • El-Gharbawy AH, et al. Follow-up of a child with pyruvate dehydrogenase deficiency on a less restrictive ketogenic diet. Mol Genet Metab. 2011 Feb;102(2):214-5. PubMed
    • Wexler ID, et al. Outcome of pyruvate dehydrogenase deficiency treated with ketogenic diets. Studies in patients with identical mutations. Neurology. 1997 Dec;49(6):1655-61. PubMed
    • Wijburg FA, et al. Leigh syndrome associated with a deficiency of the pyruvate dehydrogenase complex: results of treatment with a ketogenic diet. Neuropediatrics. 1992 Jun;23(3):147-52. PubMed
    • Falk RE, et al. Ketonic diet in the management of pyruvate dehydrogenase deficiency. Pediatrics. 1976 Nov;58(5):713-21. PubMed
  • Refractory Status Epilepticus

    Clinical References for Refractory Status Epilepticus.

    • Cervenka MC, et al. The ketogenic diet for medically and surgically refractory status epilepticus in the neurocritical care unit. Neurocrit Care. 2011 Dec;15(3):519-24. PubMed
    • Nam SH, et al. The role of ketogenic diet in the treatment of refractory status epilepticus. Epilepsia. 2011 Nov;52(11):e181-4. PubMed
    • Wusthoff CJ, et al. The ketogenic diet in treatment of two adults with prolonged nonconvulsive status epilepticus. Epilepsia. 2010 Jun;51(6):1083-5. PubMed
    • Kumada T, et al. Modified Atkins diet for the treatment of nonconvulsive status epilepticus in children. J Child Neurol. 2010 Apr;25(4):485-9. PubMed
  • Generalized vs. Focal Epilepsy

    Clinical References for Generalized vs. Focal Epilepsy.

    • Kayyali H, et al. A. The Ketogenic Diet Efficacy in Generalized vs Focal Epilepsy (abstract). In: American Epilepsy Society’s Annual Meeting; 2 Dec 2011-6 Dec-2011; Baltimore, MD. Abstract 2.293. Abstract
  • Non Ketotic Hyperglycinemia

    Clinical References for Non Ketotic Hyperglycinemia.

    • Cusmai R, et al. Ketogenic diet in early myoclonic encephalopathy due to non ketotic hyperglycinemia. Eur J Paediatr Neurol. 2012 Jan 17. [Epub ahead of print] PubMed
  • CDKL5 Mutation

    Clinical References for CDKL5 Mutation.

    • Moseley BD, et al. Historic, Clinical, and Prognostic Features of Epileptic Encephalopathies Caused by CDKL5 Mutations. Pediatr Neurol. 2012 Feb;46(2):101-5. PubMed

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