Treatment of drug-resistant epilepsy: diet or pill?

Drug-resistant epilepsy in children is a serious condition that leads to long-term mortality and disability. Early and effective treatment of drug-resistant epilepsy is important to halt its progression, which can be further exacerbated by the cumulative adverse effects of antiseizure medications and uncontrolled seizures. If two antiseizure medications have previously been tried unsuccessfully, further treatment options to be considered include another antiseizure medication or an alternative therapy, such as a ketogenic diet or surgery. 1 Perucca E Perucca P White HS Wirrell EC Drug resistance in epilepsy. Lancet Neurol. 2023; 22: 723-734 Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar However, the evidence to guide clinical decision-making regarding the best choice from these options needs to be obtained from randomised clinical trials. Classic ketogenic diet versus further antiseizure medicine in infants with drug-resistant epilepsy (KIWE): a UK, multicentre, open-label, randomised clinical trialIn this phase 4 trial, a ketogenic diet did not differ in efficacy and tolerability to a further antiseizure medication, and it appears to be safe to use in infants with drug-resistant epilepsy. A ketogenic diet could be a treatment option in infants whose seizures continue despite previously trying two antiseizure medications. Full-Text PDF Open Access