The ketogenic diet all grown up—Ketogenic diet therapies for adults

•Several new studies demonstrated efficacy of the ketogenic diet therapy (KDT) in adult patients with epilepsy.•KDT might have a potential benefit in New-Onset Refractory Status Epilepticus (NORSE).•The long-term effects of KDT on bone health, cardiovascular disease risk and its use in pregnancy remain uncertain. The use of ketogenic diet therapies (KDT) in adults has expanded in the last two decades and has been accompanied by a surge of new retrospective as well as prospective studies evaluating its efficacy in adults with epilepsy. In this review article, we will highlight the recent clinical trials and advances in the use of the ketogenic diet therapy (KDT) in adult patients with epilepsy. We will analyze the responder rate in regard to the epilepsy syndrome (focal vs generalized) to identify adults who are optimal to consider for KDT. In addition to its role in treating patients with chronic epilepsy, we will explore the emerging use of the KDT in the critical care setting in adults with refractory and super-refractory status epilepticus as well as other neurologic disorders. Finally, we will discuss special considerations for the use of KDT in adults with epilepsy including its potential long-term effects on bone and cardiovascular health, and its use in pregnancy.