Perspectives on the metabolic management of epilepsy through a dietary reduction of glucose and elevation of ketone bodies. A dietary reduction in blood glucose levels will increase ketone utilization for energy. This is expected to shift the neural environment from excitation to inhibition through multiple integrated systems. Abbreviations: GLUT-1 (glucose transporter), MCT (monocarboxylate transporter), PFK (phosphofructokinase), PDH (pyruvate dehydrogenase), SCOT (succinyl-CoA-acetoacetate-CoA transferase), β-OHB (β-hydroxybutyrate), β-HBDH (β-hydroxybutyrate dehydrogenase), NPY (Neuropeptide Y), GABA (gamma-aminobutyric acid). Modified from Seyfried et al., 2004 .