Neurol Case Rep | Volume 2, Issue 1 | Research Article | Open Access

Factors Affecting the Efficacy, Tolerability and Compliance of Dietary Therapy for Epilepsy- Four-Years Experience

Remi Banuelos1, Erin Beavis3, Fleur Le Marne1,3, Natalie Rowe2, Yajuan Gao2, Jessica Menzies2, Michelle A Farrar1,3 and Michael Cardamone1,3*

1School of Women’s and Children’s Health, Medicine UNSW, University of New South Wales, Australia 2 Department of Nutrition and Dietetics, Sydney Children’s Hospital, Australia 3Department of Paediatric Neurology, Sydney Children’s Hospital, Australia

*Correspondance to: Michael Cardamone 

Fulltext PDF


Objective: To evaluate the clinical effectiveness of the Ketogenic Diet (KD) in children as measured by: seizure reduction rates, patient side effects, patient tolerance, and compliance of 2 forms of the KD, the classical and modified Atkins KDs (MAKD). Study Design: A single-centre, retrospective study of 43 children with Intractable Epilepsy (IE) commencing the KD between 2012 and 2015. We assessed patient demographics, history of epilepsy, nutritional management, side effects of the KD, growth parameters and biochemistry records. Compliance and tolerance of the KD were explored by recording reasons for modification and cessation. Results: The median age at initiation was 3 years 10 months (range 4 months to 12 years), and the median duration of therapy was 1 year and 4 months. Twenty-five of 43 children (58%) had epileptic encephalopathies. Thirty-five (81%), 26 (60%) and 18 (42%) of children remained on the diet at 3, 12 and 24 months. Of those, 7 (16%), 4 (9%) and 5 (12%) achieved seizure freedom, and 20 (47%), 15 (35%) and 10 (23%) patients achieved >50% reduction in seizures at 3, 12 and 24 months respectively. Seizure reduction was significantly associated with diet duration (p<0.005), and reduction in anti-epileptic medications (p<0.005). Reasons for diet discontinuation included no improvement in seizures (26%), poor compliance (9%), adverse effects (9%) and weight loss (9%). Conclusion: The classical KD and MAKD provide comparable seizure control, seizure freedom and reduction in medication, particularly for those who commit to remaining on the KD out to 24 months.


Keywords: Patient compliance/adherence; Diet persistence; Adverse effects; Treatment outcome; Modified atkin’s diet


Banuelos R, Beavis E, Le Marne F, Rowe N, Gao Y, Menzies J, et al. Factors Affecting the Efficacy, Tolerability and Compliance of Dietary Therapy for Epilepsy- Four-Years Experience. Neurol Case Rep. 2019; 2(1):1010.

Subscribe to Our Newsletter