Long-Term Benefits Of Keto Diet In Severe Childhood Seizures

What was studied

This retrospective cohort study looked at children with super refractory status epilepticus (SRSE) who were started on the ketogenic diet at one center from 2009 to 2024.

There were 31 children in total, including 18 girls, with a median age of 6.8 years. Twenty-one had NORSE, including 14 with FIRES. The researchers collected information on clinical profile, etiology, ketogenic diet efficacy for electroclinical SRSE resolution, tolerability and adverse effects, duration of diet continuation, seizure control, and functional outcomes at follow-up.

What they found

After ketogenic diet initiation, 17 of 31 children (54.8%) had electroclinical resolution of SRSE. Eighteen children (58%) continued the diet for a median of 1.9 years.

At a median follow-up of 3.1 years, 7 children were seizure free, and all 7 were in the NORSE group. Eight more had partial seizure control. Eleven children, including 9 with NORSE, had favorable functional outcomes based on the study's reported mRS and PCPCS thresholds. The authors described the ketogenic diet as safe and effective in this group and suggested it may offer sustained benefits when continued beyond 6 months.

Limits of the evidence

This was a small retrospective study from a single center, so the findings may not apply to all children or settings.

There was no comparison group of children who did not receive the ketogenic diet, so the study cannot show how much of the observed improvement was specifically related to the diet. The abstract also provides limited detail about adverse effects, tolerability findings, and factors linked to better outcomes.

For families and caregivers

For families facing SRSE, this study suggests the ketogenic diet may help some children during SRSE and may be associated with longer-term seizure and functional outcomes in some cases.

However, this study does not show that the diet will help every child, and the abstract notes that the best duration of treatment remains uncertain. Families may view this as evidence that the ketogenic diet is a treatment option to discuss with a child's epilepsy and intensive care team.

What to watch next

Future studies could help clarify long-term outcomes, which children are most likely to benefit, adverse effects over time, and the optimal duration of ketogenic diet treatment after SRSE resolves.

Terms in this summary

ketogenic diet

A high-fat, very low-carbohydrate medical diet used to help control seizures.

super refractory status epilepticus

A very severe seizure emergency that continues or returns despite intensive treatment.

electroclinical resolution

Stopping of seizure activity based on both clinical signs and brain wave testing such as EEG.

NORSE

New-onset refractory status epilepticus, a severe seizure emergency without a clear cause at the start.

FIRES

Febrile infection-related epilepsy syndrome, a subtype of NORSE that follows a recent fever or infection.

modified Rankin scale

A scale that measures disability and how much help a person needs in daily life.

Pediatric Cerebral Performance Category Scale

A scale used to rate brain function and recovery in children after serious illness or injury.