Table 2.

KD in the Treatment of Refractory Seizures—Outcomes

Study/YearnDietSeizure Free (% of Total)>90% Decrease (% of Total)>50% Decrease (% of Total)AED UseComments
Hopkins and Lynch/197034Classic KD. 3:1 fat/protein ratio8.8% (3/34)NRNRNROther response categories: “much improvement (29%),” “moderate improvement (42%)”
Huttenlocher et al/197112MCT diet33% (4/12)NRNRNRGI symptoms in 33% of patients (4/12), leading to discontinuation of diet in one patient
Janaki et al/197615Classic KD. 4:1 fat/protein ratio20% (3/15)NR100% (15/15)Study performed in India. Variation in diet as compared to United States
Huttenlocher/197618MCT diet22% (4/18)56% (10/18)89% (16/18)NRCorrelation found between plasma level of ketone bodies and anticonvulsant effect
Berman/197818MCT dietMCT-5.6% (1/18) Classic-25% (2/8)NR33% (6/18) 50% (4/8)NRConcluded results superior with classic KD, no statistical tests performed
Trauner/198517MCT diet29% (5/17)NR29% (5/17)NR3 patients discontinued diet after 3–4 y and remained seizure-free. 29% of patients could not comply with diet
Sills et al/198650MCT diet16% (8/50)24% (12/50)44% (22/50)4/8 patients 1 with complete control and required no further AEDs4 children stopped diet after 2 or more y of treatment with no recurrence of seizures
Schwartz et al/198959Classic KD: 15 patients MCT diet: 22 patients Modified MCT: 13 patients Mixed: 9 patientsNR41% (26/63)* 81% (51/63)NRResults for 63 studies in 55 children. Trend toward lesser response in adults. No significant differences in effect by type of diet
Kinsman et al/199258Classic KD. 4:1 fat/protein ratioNR29% (17/58)38% (22/58)For improved patients
(n = 39): 10% discontinued all AEDs. 64% had reduction
3 patients with adverse effects severe enough to stop diet. Compliance ∼90% at 6 months in patients who responded with >50% reduction
Vining et al51Classic KD. 4:1 fat/protein ratio 3 mo: 12% (6/51)
 6 mo: 12% (6/51)
12 mo: 10% (5/51)
25% (13/51)
29% (15/51)
22% (11/51)
54% (28/51)
53% (27/51)
40% (20/51)
Details of AED use NRProbability of remaining on diet closely related to efficacy in decreasing seizures
Freeman et al, unpublished data150Classic KD. 4:1 fat/protein ratio 3 mo: 3% (4/150)
 6 mo: 3% (5/15)
12 mo: 7% (11/150)
33% (50/150)
32% (48/150)
27% (41/150)
60% (89/150)
51% (77/150)
50% (75/150)
Some patients had decrease in AED use. Details NRProbability of remaining on diet closely related to efficacy in decreasing seizures
  • KD indicates ketogenic diet; MCT, medium chain triglyceride; GI, gastrointestinal; NR, no report.