Ketogenic diet: an alternative treatment for refractory epilepsy in children.
Level 4 - case-series / case-control
Prospective single-arm open trial without a control group (case series)
What was done
A prospective, single-arm open-label study evaluated the feasibility and efficacy of a ketogenic diet program in 35 children (16 boys, 19 girls; mean age 5.37 ± 3.57 years) with refractory epilepsy in Thailand over a 4-year enrollment period. Children were placed on a modified classic 4:1 ketogenic diet that incorporated locally accessible fat sources like coconut milk. Parents were trained during hospital admission on meal preparation and daily urine ketone testing, followed by regular neurology and nutrition clinic visits. Seizure reduction, antiepileptic drug (AED) use, and side effects were monitored over an average diet duration of 7.67 months (range 6 days to 29 months).
What was found
Among patients remaining on the diet, at least a 90% reduction in seizures was achieved in 62.5% at 1 month, 68.18% at 3 months, 75% at 6 months, and 66.67% at 12 months. The number of antiepileptic drugs used by each patient also decreased as seizure control improved.
Why it matters
This study demonstrates that the ketogenic diet can be adapted to local food sources such as coconut milk and implemented in resource-limited settings where newer antiepileptic medications are cost-prohibitive.
Limits
The study was uncontrolled and open-label. The sample size was small (n = 35), and reported efficacy figures represent only children who remained on the diet rather than an intention-to-treat analysis, introducing substantial survivorship bias. Exact retention rates at each time point and specific side effect frequencies were not reported in the abstract.
Cited by
- supports The classical ketogenic diet used for drug-resistant epilepsy consists of approximately 85% to 90% fat and 8% to 10% protein.