Human studies on the effects of ketogenic diets therapy on different types of epilepsy

Authors/CountryIntervention characteristicsMain findings
Sharma et al. [86]/India

  • N = 95 children (2–14 years old) with drug-refractory epilepsy.

  • N = 46 MAD, N = 49 controls, 3 months, RCT.

MAD was found to be effective and well tolerated in children with drug-refractory epilepsy.
Wibisono et al. [87]/Australia

  • N = 48 children (mean 3.8 years old) with intractable epilepsy.

  • KD, MCT, and MAD treatment, 9 years, retrospective study.

Lower rates of side effects were scored for MAD. The three KDs were comparably effective in seizure control and tolerability.
Kim et al. [88]/Korea

  • N = 104 patients aged 1–18 years old with refractory epilepsy.

  • N = 53 MAD, N = 51 KD, 6 months, RCT.

MAD may be considered as the primary choice for the treatment of intractable epilepsy in children. KD is more suitable as diet therapy in children < 2 years of age.
Lambrechts et al. [89]/The Netherlands

  • N = 48 patients aged 1–18 years old with refractory epilepsy.

  • N = 26 KD, N = 22 control, 4 months, RCT.

KD is an effective therapy for children and adolescents with refractory epilepsy.
Kverneland et al. [90]/Norway

  • N = 62 patients aged > 16 years old with at least 3 seizures/month.

  • N = 28 MAD, N = 34 control, 3 months, RCT.

A significant reduction in seizure frequency was achieved with the MAD treatment compared to control.
McDonald et al. [91]/USA

  • N = 80 adult patients > 18 years old with drug-refractory epilepsy and at least 4 seizures/month.

  • MAD and MAD + KetoCal, 2 months, RCT.

MAD significantly reduced seizures at the end of the treatment.
Park et al. [92]/Korea

  • N = 16 children (mean age of seizure onset 8 years) with super-refractory status epilepticus (SRSE).

  • KD treatment. 12 years, retrospective study.

KD may be a feasible and safe therapeutic approach for SRSE patients in reducing the frequency of seizures.
Sondhi et al. [93]/India

  • N = 158 children (1–15 years old) with 4 or more seizures/month.

  • N = 52 MAD, N = 52 KD, N = 54 LGIT, 6 months, RCT.

LGIT diet showed a balance between seizure reduction and relatively fewer adverse events compared to MAD and KD.
Shegelman et al. [94]/USA

  • N = 60 patients with chronic epilepsy (19–75 years old).

  • N = 36 MA, N = 24 control, 3 months, retrospective study.

Lower seizure frequency was significantly associated with anxiety symptoms. MAD had a positive input on psychological state independent of seizure reduction or KB production.
Rafli et al. [95]/Indonesia

  • N = 31 children (2–18 years old) with intractable epilepsy.

  • MAD treatment for 6 months, pilot experimental study.

MAD reduced the seizure frequency by 50% in the first month, 62% in the third, and > 83% in the sixth month.

KD: ketogenic diet; MAD: modified Atkins diet; MCT: medium-chain triglyceride; LGIT: low glycemic index therapy diet; RCT: randomized controlled trial; KB: ketone body