Therapeutic Efficacy of the Ketogenic Diet in Pediatric Refractory Epilepsy

Details

Supervisors

Lagae, Lieven ; Cilio, Maria-Roberta

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master [120] en sciences pharmaceutiques, à finalité spécialisée

Abstract

enDrug-resistant epilepsy (DRE) affects approximately one-third of pediatric patients with epilepsy and is characterized by persistent seizures despite adequate administration of antiseizure medications. For children who are not candidates for epilepsy surgery or who do not respond to pharmacological treatments, ketogenic dietary therapies (KDTs) constitute an established non-pharmacological treatment option. This thesis evaluates the therapeutic efficacy, safety, and clinical relevance of ketogenic diets as adjunctive treatments in pediatric DRE, with particular attention to Dravet syndrome and Lennox–Gastaut syndrome. KDTs are consistently associated with clinically meaningful seizure reduction. Pooled analyses indicate that children receiving ketogenic diets are more likely to achieve a greater than 50% reduction in seizure frequency compared with usual care. Higher levels of seizure reduction and seizure freedom are observed in a smaller proportion of patients. Comparative analyses reveal no significant differences in efficacy among the classic ketogenic diet, the modified Atkins diet, and the low glycemic index treatment. Adverse effects are primarily gastrointestinal and metabolic, and treatment discontinuation is mainly related to tolerability and caregiver burden. In Dravet and Lennox–Gastaut syndromes, ketogenic diets are associated with substantial seizure reduction, particularly during early treatment phases. These findings highlight the role of ketogenic dietary therapies within a multidisciplinary approach to pediatric DRE and underscore the need for further research to optimize patient selection, long-term outcomes, and treatment adherence.