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The ketogenic diet (KD) is an established, effective nonpharmacologic treatment for intractable childhood epilepsy. The KD is provided differently throughout the world, with occasionally significant variations in its administration. There exists a need for more standardized protocols and management recommendations for clinical and research use. In December 2006, The Charlie Foundation commissioned a panel comprised of 26 pediatric epileptologists and dietitians from nine countries with particular expertise using the KD. This group was created in order to create a consensus statement regarding the clinical management of the KD. Subsequently endorsed by the Practice Committee of the Child Neurology Society, this resultant manuscript addresses issues such as patient selection, pre-KD counseling and evaluation, specific dietary therapy selection, implementation, supplementation, follow-up management, adverse event monitoring, and eventual KD discontinuation. This paper highlights recommendations based on best evidence, including areas of agreement and controversy, unanswered questions, and future research.

Recurrent episodes of apnea are described in two children following overdosage of clonidine. Respiratory depression and apnea requiring intubation may not occur for up to 2½ hours following ingestion of clonidine. Hypotension was absent in one case, suggesting opposition to centrally mediated effects by peripheral alpha-agonistic activity in the presence of high serum concentrations of clonidine. General symptoms and treatment of clonidine overdosage are discussed.