Ketogenic diet therapy provision in the COVID-19 pandemic: Dual-center experience and recommendations

The current coronavirus-19 pandemic has changed dramatically how neurologists care for children and adults with epilepsy. Stay-at-home orders and resistance to hospitalizations by patients have led epileptologists to engage in telemedicine and reevaluate how to provide elective services. Ketogenic diet therapy is often started in the hospital, with families educated in hospital-based classes, but this is difficult to do in this current pandemic. At our two academic centers, both our pediatric and adult epilepsy diet centers have had to quickly consider alternative methods to both start and maintain ketogenic diet therapy. This paper provides several examples of how ketogenic diet therapy can be provided to patients in unique ways, along with recommendations from other experts and patients, learned over the past few months. •Ketogenic diet therapy can be successfully initiated in the hospital with shorter, focused admissions to minimize exposure.•Similarly, the classic ketogenic diet can be started as an outpatient with telemedicine visits for education and monitoring.•In adults, starting the modified Atkins diet has been successfully accomplished with live or recorded educational sessions.•Patients on ketogenic diets should ensure adequate high fat foods, medications, a scale and telemedicine capability.