Peer-reviewed article
Ketogenic diet therapies for the treatment of drug-resistant epilepsy in children and adults: A systematic review.
Vaccarezza MM, Sanguine VL, Balaciano G ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined randomized controlled trials of ketogenic diet therapies (KDT) for treating drug-resistant epilepsy in children and adults. The review found that in children, about 37% may achieve a 50% or greater reduction in seizures with KDT, while in adolescents and adults, 16 more people per 100 may reach this threshold compared to usual care. Side effects appeared similar to standard treatment in children, though quality of life and behavioral outcomes were rarely studied. Adherence to the ketogenic diet was slightly lower than with usual medication treatments.
Key points
- In children, 37% may achieve ≥50% reduction in seizure frequency with ketogenic diet therapy (moderate-certainty evidence)
- About 6 more children per 100 may achieve ≥90% seizure reduction, though this is low-certainty evidence
- In adolescents and adults, 16 more individuals per 100 may achieve ≥50% reduction in seizures compared with usual care
- Side effects in children showed no significant differences compared to usual care
- Adherence to ketogenic diet therapy may be slightly lower than usual medication treatment in both children and adults
Limitations
The review included only randomized controlled trials with limited follow-up (6-24 months), and studies on quality of life, cognitive outcomes, and behavioral effects were scarce and heterogeneous, preventing strong conclusions on these outcomes. The certainty of evidence varied across outcomes, particularly for higher seizure reduction thresholds and adult side effects.
Abstract
Epilepsy is a common treatable neurological condition characterized by recurrent involuntary brain activity manifested in seizures. It is estimated that around 30% of patients with this disease do not respond to initial pharmacological treatments, developing drug-resistant epilepsy. Among the non-pharmacological treatment options are ketogenic diet therapies (KDT) in its various forms. The objective of this study is to systematically review the randomized controlled trials investigating the use of KDTs in pediatric and adult drug-resistant epilepsy, according to Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The following databases: Embase, PubMed/Medline, LILACS, and the Cochrane Library, were searched and studies fitting the inclusion and exclusion criteria were included for analysis. Randomized controlled trials (RCT) with a minimum follow-up of 28 days were included. There were 1193 articles retrieved after duplicates were removed and 17 met the inclusion criteria. Eleven studies included children (up to 12 yrs) and six included adolescents from 13 years old and adults. Follow-up ranged from 6 to 24 months. In children, 37% may achieve a reduction in seizure frequency of 50% or more with in any form of KDT (moderate-certainty evidence). In addition, about 6 more children per 100 may achieve a ≥ 90% reduction, although this is supported by low-certainty evidence. In adolescents and adults, KDT may lead to a ≥ 50% reduction in seizure frequency in 16 more individuals per 100 compared with usual care (moderate-certainty evidence), but its impact on a 90% or greater reduction is uncertain due to the limited number of reported events and imprecision in available studies. Side effects in children showed no significant differences compared to usual care (low certainty), while in adults, the impact remains uncertain (very low certainty). Adherence to treatment may be slightly lower with KDT in both children and adults/adolescents compared to usual treatment, though results are inconsistent. Regarding quality of life and cognitive and behavioral outcomes, studies are scarce, heterogeneous, and of very low certainty, limiting the ability to draw strong conclusions.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Ketogenic diet therapies in various forms
- Population
- Children (up to 12 years), adolescents (13+ years), and adults with drug-resistant epilepsy
Key finding
In children: 37% may achieve ≥50% reduction in seizure frequency (moderate-certainty evidence)
MM et al. · Europe PMC · 2 Jul 2026