Ketogenic Diet Shows Significant Effect on Seizure Reduction in Children With Drug-Resistant Epilepsy

In a new study presented at the 54th Child Neurology Society (CNS) Annual Meeting, held October 8-11, 2025, in Charlotte, North Carolina, findings revealed that the ketogenic diet demonstrated efficacy in reducing seizures among children with drug-resistant epilepsy, especially in those with certain genetic backgrounds. Results also showed that early intervention and favorable clinical characteristics appeared to improve outcomes in this patient population.¹

Among 1764 children with drug-resistant epilepsy included in the analysis, 1500 patients had a clearly defined etiology, which was classified as genetic in 28.2%, structural in 37.1%, and unknown in 34.7% of cases. Presented by lead author Leena Ahmad Elayan, MS, medical student at Jordan University of Science and Technology, the study assessed ketogenic diet response in 1101 patients, defining response as a more than 50% reduction in seizure frequency for at least 3 months.

Researchers conducted a systematic review of randomized controlled trials and observational studies published in the past 10 years. Studies included those focused on children with drug-resistant epilepsy treated with the ketogenic diet, ones that assessed the efficacy of ketogenic diet, and research that reported the significance of clinical and genetic predictors affecting its efficacy. Investigators then extracted data on study design, sample size, epilepsy etiology, ketogenic diet protocols, response rates, and reported significant predictors.

Overall, 5 studies (27.8%) specifically examined the impact of genetic etiology on ketogenic diet response, with greater efficacy observed in patients with Angelman syndrome, Dravet syndrome, Down syndrome, and SCN2A mutations. Additional predictors of improved ketogenic diet response included younger age at diet initiation, shorter epilepsy duration, fewer prior antiseizure medications, higher baseline psychomotor development, and elevated baseline levels of Bifidobacteria. Authors noted that understanding these predictors may help individualize treatment strategies and improve outcomes in the management of pediatric drug-resistant epilepsy.

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Findings from a prior study of infants less than 3 months of age showed that a ketogenic diet can be effectively and tolerably administered in this patient population as a therapeutic approach to lowering seizures. Presented at the 2023 American Epilepsy Society (AES) annual meeting, held December 1-5, in Orlando, Florida, the analysis featured 26 infants who started the ketogenic diet before the age of 3 months between 2009 and 2020.²

After 3 months, 22 patients comprised the efficacy analysis, with a response rate of 72.7%. Led by Joo Hi Kim, MD, a professor of pediatric neurology at the Severance Children’s Hospital, Yonsei University College of Medicine, patients who experienced at least a 50% reduction in seizures were considered responders, whereas nonresponders included those who discontinued the diet because of poor compliance, adverse events (AEs), or the need for epilepsy surgery.

After 6 months of observation, 18 patients were assessed, and the response rate was 72.2%. When comparing clinical characteristics, patients with Ohtahara syndrome showed a significant difference in response to the ketogenic diet (P = .010), although this difference was not statistically significant when controlled for etiology. Within the 6-month time frame, 3 patients discontinued their diet because of AEs which included hypoglycemia, aspiration pneumonia, and significant weight loss because of recurrent diarrhea.

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REFERENECS
1. Elayan A, Hamed A, Atallah SH, Alsarayrah I, Alzamil M, et al. The ketogenic diet for drug resistance epilepsy in children: efficacy and predictors of response. Presented at: 2025 Child Neurology Society Annual Meeting. October 8-11; Charlotte, North Carolina. Abstract #84.
2. Kim JH, Ko A, Lee Ej, et al. Efficacy and safety of the ketogenic diet in young infants less than 3 months of age. Presented at: 2023 AES annual meeting; December 1-5; Orlando, FL. POSTER 3.328