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The role of ketogenic diet therapy in very young infants with drug-resistant epilepsy has been less certain than in older children. The KIWE trial was a multicentre randomized study comparing a classic ketogenic diet with another antiseizure medication in infants aged one to 24 months. The study found no clear difference between groups in median seizure frequency during the primary eight-week assessment period. The trial was stopped early because of slow recruitment and funding limitations, reducing its ability to detect modest treatment differences. The result is important because it tempers assumptions that ketogenic therapy should automatically replace another medication as the next step in every infant with drug-resistant epilepsy. At the same time, the study does not show that ketogenic therapy is ineffective in infancy; rather, the evidence was underpowered and the population was clinically heterogeneous. For HCPs, treatment decisions should consider epilepsy syndrome, underlying cause, feeding capacity, nutritional status, medication history and family preferences. The study demonstrates why age-specific evidence matters when applying dietary therapies to children with severe epilepsy.
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The role of ketogenic diet therapy in very young infants with drug-resistant epilepsy has been less certain than in older children. The KIWE trial was a multicentre randomized study comparing a classic ketogenic diet with another antiseizure medication in infants aged one to 24 months. The study found no clear difference between groups in median seizure frequency during the primary eight-week assessment period. The trial was stopped early because of slow recruitment and funding limitations, reducing its ability to detect modest treatment differences. The result is important because it tempers assumptions that ketogenic therapy should automatically replace another medication as the next step in every infant with drug-resistant epilepsy. At the same time, the study does not show that ketogenic therapy is ineffective in infancy; rather, the evidence was underpowered and the population was clinically heterogeneous. For HCPs, treatment decisions should consider epilepsy syndrome, underlying cause, feeding capacity, nutritional status, medication history and family preferences. The study demonstrates why age-specific evidence matters when applying dietary therapies to children with severe epilepsy.
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