Comment: The quality of evidence is downgraded by study limitations (lack of blindind) and by imprecise results (few patients).
A Cochrane review [Abstract] 1 included 13 studies with a total of 932 subjects with drug-resistant epilepsy; 711 children (4 months to 18 years) and 221 adults (16 years and over). This evidence summary only concerns children.
Children randomised to ketogenic diets (KDs) were 3 times more likely to attain seizure freedom compared to children randomised to usual care (RR 3.16, 95% CI 1.20 to 8.35; 4 studies, n=385). Children who received KDs were nearly 6 times more likely to attain a 50% or greater reduction in seizure frequency than children who received usual care (RR 5.80, 95% CI 3.48 to 9.65; 4 studies, n=385). The most commonly reported adverse effects were vomiting, constipation and diarrhoea for both the intervention and usual care group. There was no difference in study retention between KD or usual care groups (RR 1.08, 95% CI 0.74 to 1.57; 5 studies, n=425).
Up to 55% of children achieved seizure freedom with a classical 4:1 KD after 3 months whilst up to 85% of children achieved seizure reduction. Up to 25% of children were seizure free with modified Atkins diet (MAD) and up to 60% achieved seizure reduction.
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