Ketogenic diet therapy enables antiseizure medication reduction and withdrawal in children with epilepsy

Aim This study investigated the effectiveness of ketogenic diet therapy (KDT) in facilitating antiseizure medication (ASM) dose reduction and withdrawal in children with epilepsy. We aimed to determine the proportion of KDT responders able to reduce or withdraw ASMs within six months of starting KDT and to identify clinical factors associated with successful ASM withdrawal. Methods A retrospective evaluation for pediatric epilepsy patients treated with KDT at Erasmus MC-Sophia Children’s Hospital between 2008 and 2023 was conducted. Patients aged 0–18 years who successfully responded to, and remained on KDT for at least six months were included. Statistical analyses evaluated the association between clinical characteristics and ASM withdrawal. Results Of the 151 patients deemed as KDT responders, 27 % achieved successful withdrawal of at least one ASM after six months of KDT. The number of ASMs decreased from a mean of 2.6 at baseline to 2.4 at six months. Younger age at KDT initiation (OR 0.86, p = 0.018) and a lower baseline number of ASMs (OR 1.57, p = 0.016) were associated with higher odds of ASM withdrawal. Interpretation KDT is effective in enabling ASM withdrawal in one-fourth of the responding pediatric patients. Younger age and fewer initial ASMs predicted better withdrawal outcomes, supporting early ASM withdrawal within 3–6 months of KDT for appropriate candidates.