Ketogenic diet therapy is established as a treatment option for drug-resistant epilepsy, but its role alongside long-term antiseizure medication remains clinically important. This 2024 cohort study evaluated adults and children with drug-resistant epilepsy who remained on ketogenic diet therapy for at least six months. More than half of participants were able to discontinue or reduce at least one antiseizure medication without requiring another antiseizure drug or restarting the original dose during follow-up. Among adults, the overall antiseizure medication load also fell. Importantly, the ability to reduce medication was not limited to patients with a major reduction in seizure frequency, suggesting that dietary therapy may sometimes facilitate medication simplification beyond its direct effect on seizures. The study is observational and does not establish that the diet itself caused medication reduction, so treatment decisions still require individual assessment. For HCPs, the practical value lies in thinking about ketogenic therapy as part of a broader treatment strategy rather than as a substitute for all conventional medication. Monitoring nutritional status, tolerability, adherence and seizure control remains essential. The findings are particularly relevant to paediatric and difficult-to-treat epilepsy programmes considering multimodal therapy.