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Efficacy of the Ketogenic Diet as a Treatment Option for Epilepsy: Meta-analysis

Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT

Francis M. Filloux, MD

Department of Pediatric Neurology, University of Utah School of Medicine, Salt Lake City, UT, francis.filloux{at}hsc.utah.edu

Stephen C. Alder, PhD

Family and Preventive Medicine University of Utah School of Medicine, Salt Lake City, UT

Joseph L. Lyon, MD, MPH

Family and Preventive Medicine University of Utah School of Medicine, Salt Lake City, UT

Deirdre A. Caplin, PhD

Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT

The evidence base for the efficacy of the ketogenic diet was assessed among pediatric epileptic patients by application of a rigorous statistical meta-analysis. Nineteen studies from 392 abstracts met the inclusion criteria. The sample size was 1084 patients (mean age at initiation 5.78 ± 3.43 years). The pooled odds ratio, using a random effects model, of treatment success (> 50% seizure reduction) among patients staying on the diet relative to those discontinuing the diet was 2.25 (95% confidence interval = 1.69—2.98). The reasons for diet discontinuation included < 50% seizure reduction (47.0%), diet restrictiveness (16.4%), and incurrent illness or diet side effects (13.2%). The results indicate that children with generalized seizures and patients who respond with > 50% seizure reduction within 3 months tend to remain on the diet longer. Although no class I or II studies have been published regarding the efficacy of the ketogenic diet, this meta-analysis shows that current observational studies reporting on the therapeutic effect of the ketogenic diet contain valuable statistical data. Future observational studies should aim for long-term follow-up, patient dropout analysis, and improved seizure type characterization. (J Child Neurol 2006;21:193—198; DOI 10.2310/7010.2006.00044).

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