child eating

Shah et al., Epilepsy and Behavior, 93(2019), 29-31.

A ketogenic diet in children with refractory epilepsy (drugs unable to control seizures) has proven an effective method in reducing the amount of antiepileptic drugs (AEDs). These children generally move to a ketogenic diet after multiple AED failures. The ketogenic diet uses a high-fat, low-carbohydrate, protein diet to force the body into switching from using carbohydrates to using fat for its main source of energy. The best candidates for the ketogenic diet are unknown at this time.


The purpose of this study was to further explore the relationship between the ketogenic diet and pediatric epilepsy by looking at the number of children no-longer needing AEDs after using the ketogenic diet. Researchers also looked at how they remained off AEDs, what seizure types responded best to the ketogenic diet, and the timeline and reasons that children resumed AED therapy.

Description of Study

  • 232 children on AEDs and the ketogenic diet from John Hopkins Hospital and John Hopkins All Children’s Hospital were enrolled in the study
  • Data was collected from chart review between January 2011 and April 2018
    • Seizure activity status was obtained from parents at clinical visits and email and phone conversations
  • AEDs were not weaned off until at least 1 month of being on the ketogenic diet
  • Drug-free diet status was labeled as 1 week continuously of the ketogenic and no AEDs
  • Length of drug-free diet status and restarting AEDs was documented
  • Children who achieved drug-free diet status were compared to those who remained on AEDs

Summary of Study Findings

  • After 3 months of ketogenic diet, 70% had more than half of their seizures eliminated and 20% were seizure free
  • Just under 20% of children in the study achieved drug-free diet status and 13.8% remained drug free long term
    • For drug-free diet status children, 63% were seizure free, 28% had 90-99% seizure reduction, and 9% had 50-90% reduction
  • On average it took 7.5 months to reach drug-free diet status
  • Children who were younger, on fewer AEDs, had Glut1 deficiency, or Doose syndrome were more likely to reach drug-free diet status
  • Children who had Lennox-Gastaut syndrome or a gastrostomy tube were less likely to reach drug-free diet status

What does this mean?

  • This study supports a ketogenic diet-AED partnership in children with refractory epilepsy.
  • Although a ketogenic diet halved seizures in 70% of children in the study, 4 out of 5 still needed to remain on AEDs.
  • This study also identified a few positive and negative predictive factors for achieving drug-free diet status on a ketogenic diet.
  • This information is valuable for setting expectations with parents who are considering starting a ketogenic diet with their children and weaning them off of AEDs.

Article published in Epilepsy & Behavior, April 2019.

Authored By: 
Luca Farrugia MS2
Authored Date: 
Reviewed By: 
Joseph I. Sirven MD
Sunday, August 11, 2019