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Question 1 Efficacy of the ketogenic diet in difficult childhood epilepsies

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Scenario

You are a paediatric neurology registrar carrying out an epilepsy clinic. You see a child with difficult epilepsy who has been tried on various combinations of antiepileptic medications, but optimal seizure control has not been achieved. You wonder if he should be put on the ketogenic diet, but are not sure if there is enough research evidence to justify its use. You decide to examine the evidence.

Structured clinical question

In a child with difficult epilepsy [subject] does use of the ketogenic diet [intervention] help to reduce seizures [outcome]?

Search strategy and outcome

Primary sources

Medline and Embase (1974 to September 2009) were searched via the OVID interface using the text words ‘ketogenic diet’ and ‘epilepsy’, limited to human and English.

A total of 646 articles were found. All the abstracts were read. Four systematic reviews, one randomised controlled trial (RCT), one prospective cross-over study, several retrospective and prospective uncontrolled observational studies and a few case series were identified. All four systematic reviews were examined in detail. One of the more recently published systematic reviews which involved rigorous meta-analysis was included, along with a single RCT. All three prospective observational studies, published after the systematic review discussed here, were also included (see table 1). The model and design of the small prospective cross-over study1was not found suitable for analysis. All retrospective uncontrolled observational studies and small case series were excluded.

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Table 1

Use of the …

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