A decade of studies summarized at the 54th Child Neurology Society Annual Meeting indicate the ketogenic diet (KD) can substantially reduce seizure frequency in children with drug-resistant epilepsy, with responsiveness especially notable in genetic etiologies such as Angelman, Dravet, Down syndrome, and SCN2A mutations. Across 1764 children—1101 with evaluable outcomes—predictors of better KD response included younger age at initiation, shorter epilepsy duration, fewer prior antiseizure medications, higher baseline psychomotor development, and higher baseline Bifidobacteria levels. These factors may help clinicians individualize KD candidacy and timing. Notably, benefit signals were observed across protocol variants, suggesting efficacy is not strictly protocol-dependent.
Infant data suggest feasibility even before 3 months of age: a cohort starting KD in early infancy showed response rates of approximately 73% at both 3 and 6 months (≥50% seizure reduction). Adverse events led some to discontinue (eg, hypoglycemia, aspiration pneumonia, weight loss from diarrhea), underscoring the need for close monitoring and nutrition support. These findings support early, genetics-informed counseling and a monitored KD trial in appropriate candidates. Future work should standardize predictive markers (eg, microbiome signatures, genetic panels) and care pathways to improve safety, adherence, and durability of benefit.
Reference: Ciccone I. Ketogenic Diet Shows Significant Effect on Seizure Reduction in Children With Drug-Resistant Epilepsy. NeurologyLive. Published October 21, 2025. Accessed November 4, 2025. https://www.neurologylive.com/view/ketogenic-diet-shows-significant-effect-seizure-reduction-children-drug-resistant-epilepsy
