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Modified ketogenic diet for epilepsy

A modified ketogenic diet is a treatment for people whose epilepsy is difficult to treat with medication. The modified ketogenic diet has most often been used for children and adolescents, but it is increasingly being used in adults as well. The diet is used as a medical treatment to reduce seizures or to treat GLUT1 deficiency syndrome (glucose transporter type 1 deficiency syndrome) and PDH deficiency (pyruvate dehydrogenase deficiency).

Epilepsy

With a ketogenic diet, most of the energy in food comes from fat and very little from carbohydrates.

During treatment, blood sugar levels fall and the body switches to burning fat. When fat is burned, the liver produces ketone bodies (ketones). This is called ketosis. The brain uses ketone bodies as a source of energy instead of glucose (sugar).

Just under half of patients who start dietary treatment for epilepsy achieve a reduction in seizures. The diet can also have a positive effect on concentration, attention, sleep, mood and behavior. The exact mechanism behind its seizure-reducing effect is not known.

Referral and assessment

Children, adolescents and adults with epilepsy who do not achieve seizure control with medication may be referred to specialist health services for assessment for ketogenic diet treatment.

In Norway, the National Center for Epilepsy (SSE) at Oslo University Hospital has national responsibility for ketogenic diet treatment for patients with drug-resistant epilepsy. The diet team here consists of doctors, nurses and clinical dietitians with knowledge of and experience in ketogenic diets. Other professional groups are involved when needed.

All referrals to SSE must be sent via Oslo University Hospital's referral reception

 

For referrals to the National Center for Epilepsy, see the specific referral criteria here 

Before

Patients and, if applicable, their family members attend an information and assessment appointment at the National Center for Epilepsy (SSE) before starting the diet.

Seizure recording

  • Seizures must be recorded for at least one month before starting the diet. This provides a basis for assessing the effect of the diet on seizures. Fewer, shorter or less severe seizures are important changes.
  • Use a seizure diary to record seizure type, frequency and duration. Also note any changes in well-being.
  • For patients with a very large number of seizures, counting every seizure may be too difficult. In that case, you can do the following:
    • Many seizure types: Record only the seizure types that have the greatest impact. These are the seizures that are primarily targeted for reduction.
    • Frequent seizures: For example, choose one hour each day when seizures tend to be frequent, and record all seizures. Record them at the same time each day.

How can I prepare?

Bring the following when starting the diet:

  • Seizure diary
  • List of medications and dietary supplements
  • Computer (PC/Mac)

During

You are usually admitted for a 3–5-day training stay. For children, both parents are advised to attend. The diet treatment is started at home on the first Monday after discharge.

The department offers training for other caregivers via video consultation.

Diet principles

Carbohydrate intake is restricted to a very low level. Foods containing carbohydrates are weighed using a digital kitchen scale accurate to 1 gram. Carbohydrates in meals mainly come from vegetables, fruit, berries, nuts and seeds. Plenty of fat is recommended, for example from oils, margarine and full-fat dairy products. You can also eat some protein-rich foods, such as chicken, meat, fish, eggs and cheese. Vitamin and mineral supplements are necessary.

Meals

The diet usually consists of four to five meals per day. During treatment, you should not skip meals or go more than 4–5 hours between meals during the day. The amount of carbohydrates should be distributed roughly evenly across the day's meals. The amount of food is adjusted to your appetite. It is important to drink plenty of fluids to keep your body hydrated and avoid constipation, as well as to prevent kidney stones.

Adjusting the diet

It usually takes some time before we see an effect from dietary treatment. We recommend trying the diet for at least three months. During this time, adjustments to the ratio, energy and carbohydrate intake may sometimes be needed to determine what gives the best seizure reduction. The required duration of dietary treatment is assessed individually.

Read more about the diet team

After

Follow-up at home

This treatment requires close follow-up at home:

  • Record seizures and information about general health. Important observations include appetite, nausea, constipation, sleep patterns, attention and any infections.
  • Measure blood sugar and blood ketones in the morning and evening twice a week during weeks 1 and 2. After that, the need to measure ketosis is assessed individually.
  • Body weight once a week before breakfast for the first three months. After that, once a month.
  • Three-day weighed food records after 2, 10 and 22 weeks on the diet, and then every 6 months.


Follow-up at the National Center for Epilepsy, SSE

The first check-up is 4 weeks after starting the diet. The next check-up is three months after starting, and then every 3 months until the 1-year check-up. After that, check-ups take place every 6 months or as needed. At check-ups, the nurse, clinical dietitian and doctor review blood tests, urine tests, weight and height.

Tapering epilepsy medication and the need for EEG recording are assessed individually.

Preparing for an outpatient diet check-up:

  • Blood tests approximately 14 days before the appointment. These can be taken at the laboratory at your local hospital or at SSE (go to the laboratory). Bring the request form/document enclosed with your appointment letter. Remember that blood tests must be taken in the morning, before medication and breakfast (fasting from food and medication).
  • Seizure diary (total each seizure type and seizure-free days for the 28 days before the check-up)
  • List of medications and dietary supplements
  • Fasting weight and height
  • Blood sugar and blood ketones before a meal, once in the morning and once in the evening
  • Three-day food record

Preparing for a diet check-up with admission:

  • Seizure diary
  • Overview of medications and dietary supplements
  • Overview of measured blood glucose and blood ketone levels
  • 3-day food diary

Please note

Discomfort caused by high ketone levels or low blood sugar can occur during the initial phase, but also later. The symptoms of low blood sugar and high blood ketone levels can be relatively similar. In both cases, the measures involve giving fast-acting carbohydrates, which will raise blood sugar and lower blood ketone levels.

Symptoms of low blood sugar and/or high blood ketone levels:

  • lethargy
  • paleness
  • irritability
  • nausea
  • loss of appetite
  • tremors
  • rapid breathing

Give 30 ml of apple or orange juice if:

  • blood sugar is below 3 mmol/L and symptoms are present
  • blood sugar is 2.5 mmol/L or lower
  • blood ketone levels are high and symptoms are present
 
Note that if the patient has no symptoms from high ketone levels, no treatment is needed unless blood ketone levels exceed 7–8 mmol/L.
 
Check blood sugar and ketone levels after giving juice. Repeat the procedure if necessary. If these measures have been carried out without improvement, or if the child has impaired consciousness, contact a doctor.

Side effects

Most people tolerate the dietary treatment well. Side effects that may occur include:
  • constipation
  • low blood sugar
  • nausea
  • vomiting
  • worsening reflux (heartburn)
  • fatigue
  • unwanted weight loss
  • ketoacidosis (excessive acidity in the blood)
  • elevated blood fat levels
  • reduced growth
  • menstrual irregularities
  • increased seizures
  • osteoporosis
  • kidney stones
  • pancreatitis (very rare)




Last professionally updated 20.01.2026

Contact

Sørlandet Hospital Arendal Department of Paediatrics and Adolescent Medicine (BUA), Arendal

Contact the Department of Paediatrics and Adolescent Medicine (BUA), Arendal

Where to attend

Please go to the reception at the paediatric department, 6E, on the 6th floor of the main building



Sørlandet sykehus Arendal sett fra luften.

Sørlandet Hospital Arendal

Sykehusveien 1

Sykehusveien 1, 4838 Arendal

Find your way

Transport

You can reach our locations by public transport. Visit Agder public transport to find your route:akt.no

You may be entitled to reimbursement of necessary expenses when travelling to and from your treatment location.

As a general rule, you should use public transport, and you will have to pay a co-payment. To be reimbursed for travel expenses you have paid, you must complete a travel expense claim form and send it toPatient travel.

Practical information

At the hospital pharmacy in Arendal, you can fill prescriptions and buy pharmacy products.
You’ll find us on the ground floor of the main building, just inside the entrance.
Open weekdays from 08:30 to 16:00.

Arendal Hospital Pharmacy

Doesn’t the appointment work for you? If you receive your appointment letter digitally on helsenorge.no, you can now send a message directly to the department you are due to visit if you need a new appointment time. You must be a registered user of Helsenorge to access the service.
You can also contact the department where you have an appointment or call the switchboard on: 38 07 30 00
​

Children and young people are affected when someone in the family is ill, and need to understand what is happening. You may be a patient yourself, a next of kin, or a parent of sick children with siblings. We at the hospital will help ensure that the children and young people in your family are well cared for.

Children as next of kin


Visiting hours may vary between departments and locations. Please check with the department where you have an appointment for more information.

See an overview of the hospital’s departments

General visiting hours:

Arendal:
17:00–19:00 on weekdays
14:00–16:00 and 18:00–19:00 on weekends and public holidays

Flekkefjord:
14:00–15:00 and 18:00–19:00
Maternity ward: 17:00–19:00 (quiet time/no visits: 14:00–16:00)

Kristiansand:
17:00–19:00 on weekdays
14:00–16:00 and 18:00–19:00 on weekends and public holidays

Maternity ward: 16:00–18:00 every day for the newborn’s healthy siblings.

The patient library in Arendal is located in the basement of the main building. It is self-service and open around the clock. Here you can borrow books and read newspapers and magazines.

Many people wish to bring flowers when visiting a patient at the hospital, but due to allergies and the risk of infection, several of our departments are flower-free. We appreciate it if you choose something other than flowers when bringing a gift for a patient.

Some patients also have allergic reactions to perfume or perfumed creams. Please be considerate.

Many patients and next of kin want to take photos/videos or blog about their time in hospital. This is of course permitted, as long as you respect the privacy of other patients and staff.

Here are a few tips for using social media if you are a patient or next of kin:

  • Be considerate of others. You must have consent if you want to take photos or videos of patients or staff. All patients are entitled to privacy while in hospital.
  • Parents/guardians decide whether you can take photos of children or publish photos of their children online. Parents should consider what is best for the child. Once the child has turned 12, considerable weight must be given to the child’s views. Once the child has turned 15, they decide for themselves whether they are comfortable being photographed and whether the photos may be published.
  • Remember that staff must also give their permission if you want to publish photos you have taken of them.
  • You should remove content you have published if the person concerned asks you to. If someone has posted photos of you online without your permission, you can ask them to delete them. If they do not comply, you can contact: www.slettmeg.no.

Audio recordings
It is not illegal to record conversations in which you take part for private use. However, publishing and sharing recordings requires consent from the person you are speaking with. Secretly recording conversations in which you do not participate is illegal.

Have you worked in healthcare or received healthcare outside the Nordic countries in the past year?

This may include, for example, a hospital stay, extensive outpatient treatment or a visit to the dentist. In that case, your GP must test you for bacteria that are resistant to antibiotics (for example, MRSA).

Ask your GP to send you the test result before your appointment with us, and bring it with you when you come to the hospital.

For a day stay or hospital admission, please bring the following to the hospital:

  • Bring indoor shoes, a change of clothes and toiletries
  • Bring your regular medication. It may take time to obtain equivalent medication from the pharmacy.
  • Bring a list/overview of your regular medications
  • Medical equipment for everyday use

Sometimes we need a room for rest and reflection. We have three such rooms available for you and your next of kin. The rooms are open to everyone, regardless of beliefs or faith.

In Arendal, the hospital’s quiet room/chapel is in the basement of the main building. In Kristiansand, the room is on the ground floor of the main building, north entrance. Both rooms are open around the clock. In Flekkefjord, the chapel is by the car park, to the left of the main entrance.

It is also possible to hold a memorial service in the chapel in the event of a death. Please contact the hospital chaplains to arrange this.

Eg Church in Kristiansand is open every weekday from 08:00 to 18:00 for those who would like a quiet space for reflection. Open from 10:00 to 18:00 on weekends.

Kiosk
The kiosk is located in the lobby on the first floor.

The kiosk sells items such as newspapers, magazines, fruit, chocolate, biscuits, ice cream, soft drinks, cards, flowers, some toiletries and various gifts.

You can also buy sweet buns, chicken wraps, bread rolls, salads, calzone, panini and hot dogs.

Opening hours:
Monday-Friday: 07:00-21:00
Saturday and Sunday: 09:00-20:00

Parking spaces at Sørlandet Hospital are subject to a fee Monday to Friday from 08:00 to 20:00. Anyone who wishes to park on hospital grounds must follow the signs and instructions on the payment machines.

At the hospitals in Arendal and Kristiansand, you can pay for parking with EasyPark (mobile app) or by card at other locations. See the signs for payment options and time limits.

At the hospital in Kristiansand, you can register your parking via the EasyPark app, at the machine where you park, or on the Flowbird website.

Register payment on the website

Overview of parking spaces at Eg in Kristiansand
 

At the hospital in Arendal, cameras read vehicle registration numbers when entering and leaving the parking garage through the Autopay service. Follow the signs and read the instructions.

Pay at the payment machine

If you have not created a profile onAutopay.io​, you can pay at the machine by the main entrance. Enter the vehicle’s registration number. You can pay by card.

Pay automatically

Register as a customer with your registration number and bank card at www.autopay.io. Once registered, you will pay automatically each time you park in the parking garage.

During certain periods, for example when there is a lot of snow, it can be difficult to find a parking space. We therefore recommend allowing plenty of time.

For electric cars:

Electric cars are charged a fee from the first hour.

Do you need to charge your car? Not all our hospital sites have charging stations, and those that do have a limited number. You therefore cannot count on being able to charge your car while you are inside as a patient or visitor. You can see all charging stations here:

All charging stations on one map - Norwegian EV Association​

Blood donors can park for free at the hospital.
For more information, contact the blood bank.


Guardians of children (under 18) who have been in hospital for more than 14 daysare entitled to free parking for the remainder of the child’s stay. This also applies if the child’s stay begins at another hospital. Contact the hospital department for more information.

A valid disabled parking permit entitles you to free parking in designated spaces
Contact the Service Desk to register your disabled parking permit. Vehicles displaying disabled parking permits are exempt from time limits unless otherwise stated on the sign.

Parking for expectant mothers in Kristiansand
Free parking is available for expectant mothers outside the Women’s Department at the hospital in Kristiansand. The maximum parking time is 2 hours.

Care benefits compensate for lost income when you care for a child who needs constant supervision and care due to illness or injury. Read more about, among other things,care benefits, assistance and basic benefitsandNational Insurance benefitsat NAV.

The Breathing Space is a place of respite for children and young people whose seriously ill parents or siblings are admitted to hospital, or who are themselves admitted to the hospital in Arendal. The departments have keys to the room and can provide more information about the service. The room is on the basement level in wing C and has, among other things, a TV, computer and games.

Smoking can cause discomfort to others. Thank you for being considerate and helping to ensure that Sørlandet Hospital is a smoke-free environment.

The Service Desk in Arendal is located right by the main entrance. You can contact them with questions about your hospital appointment.

Opening hours:
Weekdays: 07:00-21:00.
Saturdays, Sundays and public holidays: 09:00-20:00.

Do you need someone to talk to? Our hospital chaplains have extensive experience supporting people in different life situations. They meet you on your terms, regardless of faith, beliefs or outlook on life. The hospital chaplains are available 24 hours a day, 7 days a week, for patients, relatives and staff.

Would you like to get in touch? You can ask hospital staff for help or call the switchboard on 38 07 30 00.

The hospital chaplains can also put you in touch with other faith and belief communities.

If you need an interpreter, you must notify the hospital well in advance of your appointment. Interpreter costs are covered by the health service.Helsenorge.no

Patients not fluent in Norwegian are entitled to an interpreter.Helsenorge.no/interpreter

All visitors can use free wireless internet at the hospital.

Look for HSO-Gjest in your network list and follow the instructions to log in.

If you cannot find the network, you are in an area that has not yet been set up.

If your child has been exposed to chickenpox or has chickenpox, please contact us. The scheduled appointment/admission must then be postponed. This also applies if you are planning to visit the paediatric and adolescent department. Chickenpox can be dangerous for some of our patients.

TEST VERSION
Machine-translated copy of sshf.no for testing only. Not official information.