Cochrane · systematic review · CD001903
Ketogenic diets for drug‐resistant epilepsy
Martin-McGill, KJ, Bresnahan, R, Levy, RG, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
18
No studies
6
Included studies
NR
No studies 6 · 25%Ungraded 0 · 0%Very low 15 · 62.5%Low 3 · 12.5%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyKetogenic diet (KD) compared to usual care for children with drug‐resistant epilepsy
Population: children (aged 1 to 18 years) with drug‐resistant epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (100% reduction in seizure frequency) Ketogenic diet (KD) vs usual care | RR 3.16 [1.2, 8.35] | 4 studies · 385 participants | Very low Downgraded: risk of bias, imprecision |
50% or greater reduction in seizure frequency Ketogenic diet (KD) vs usual care | 5.8 [3.48, 9.65] | 4 studies · 385 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects Ketogenic diet (KD) vs usual care | no estimate extracted | 5 studies · 425 participants | Low Downgraded: risk of bias, imprecision |
Cognition and behaviour Ketogenic diet (KD) vs usual care | no estimate extracted | 1 study · 57 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Ketogenic diet (KD) vs usual care | OR 16 | 1 study · 57 participants | Very low Downgraded: risk of bias, imprecision |
Treatment withdrawal Ketogenic diet (KD) vs usual care | RR 1.08 [0.74, 1.57] | 5 studies · 425 participants | Low Downgraded: risk of bias, imprecision |
Ketogenic diet (KD) compared to usual care for adults with drug‐resistant epilepsy
Population: adults (aged 16 years and over) with drug‐resistant epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom Ketogenic diet (KD) vs usual care | no estimate extracted | 2 studies · 141 participants | Very low Downgraded: risk of bias, imprecision |
50% or greater reduction in seizure frequency Ketogenic diet (KD) vs usual care | RR 5.03 [0.26, 97.68] | 2 studies · 141 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse effects Ketogenic diet (KD) vs usual care | no estimate extracted | 2 studies · 141 participants | Very low Downgraded: risk of bias, imprecision |
Cognition and behaviour Ketogenic diet (KD) vs usual care | no estimate extracted | NR | No studies |
Quality of life Ketogenic diet (KD) vs usual care | no estimate extracted | NR | No studies |
Treatment withdrawal Ketogenic diet (KD) vs usual care | RR 5.38 [0.42, 69.53] | 2 studies · 141 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Ketogenic diets (KDs) compared with other KDs for children with drug‐resistant epilepsy
Population: children (aged 4 months to 16 years) with drug‐resistant epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (100% reduction in seizure frequency) Ketogenic diets (KDs) vs other KDs | no estimate extracted | 5 studies · 286 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Seizure reduction (50% or greater reduction in seizure frequency) Ketogenic diets (KDs) vs other KDs | no estimate extracted | 5 studies · 286 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse effects Ketogenic diets (KDs) vs other KDs | no estimate extracted | 5 studies · 286 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Cognition and behaviour Ketogenic diets (KDs) vs other KDs | no estimate extracted | NR | No studies |
Quality of life Ketogenic diets (KDs) vs other KDs | no estimate extracted | NR | No studies |
Attrition rate Ketogenic diets (KDs) vs other KDs | no estimate extracted | 5 studies · 286 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Ketogenic diets (KDs) compared with other KDs for adults with drug‐resistant epilepsy
Population: adults (aged 18 years and over) with drug‐resistant epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (100% reduction in seizure frequency) Ketogenic diets (KDs) vs other KDs | no estimate extracted | 1 study · 80 participants | Very low Downgraded: risk of bias, imprecision |
Seizure reduction (50% or greater reduction in seizure frequency) Ketogenic diets (KDs) vs other KDs | no estimate extracted | 1 study · 80 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects Ketogenic diets (KDs) vs other KDs | no estimate extracted | 1 study · 80 participants | Very low Downgraded: risk of bias, imprecision |
Cognition and behaviour Ketogenic diets (KDs) vs other KDs | no estimate extracted | NR | No studies |
Quality of life Ketogenic diets (KDs) vs other KDs | no estimate extracted | NR | No studies |
Attrition rate Ketogenic diets (KDs) vs other KDs | no estimate extracted | 1 study · 80 participants | Very low Downgraded: risk of bias, imprecision |
Summary of Findings ‐ Ketogenic diets compared to control for people with epilepsy
Population: people with epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (100% reduction in seizure frequency) Summary of Findings ‐ Ketogenic diets vs control | no estimate extracted | 4 studies · 350 participants | Low Downgraded: risk of bias, inconsistency |
Seizure reduction (50% or greater reduction in seizure frequency) Summary of Findings ‐ Ketogenic diets vs control | no estimate extracted | 5 studies · 452 participants | Low Downgraded: risk of bias, inconsistency |
Adverse effects Summary of Findings ‐ Ketogenic diets vs control | no estimate extracted | 5 studies · 452 participants | Low Downgraded: risk of bias, inconsistency |
Cognition and behaviour Summary of Findings ‐ Ketogenic diets vs control | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life Summary of Findings ‐ Ketogenic diets vs control | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Attrition rate Summary of Findings ‐ Ketogenic diets vs control | no estimate extracted | 5 studies · 452 participants | Low Downgraded: risk of bias, inconsistency |
Summary of findings ‐ Ketogenic diets compared with other ketogenic diets for people with epilepsy
Population: people with epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom (100% reduction in seizure frequency) Summary of findings ‐ Ketogenic diets vs other ketogenic diets | no estimate extracted | 5 studies · 286 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Seizure reduction (50% or greater reduction in seizure frequency) Summary of findings ‐ Ketogenic diets vs other ketogenic diets | no estimate extracted | 6 studies · 326 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Adverse effects Summary of findings ‐ Ketogenic diets vs other ketogenic diets | no estimate extracted | 6 studies · 326 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Cognition and behaviour Summary of findings ‐ Ketogenic diets vs other ketogenic diets | no estimate extracted | NR | No studies |
Quality of life Summary of findings ‐ Ketogenic diets vs other ketogenic diets | no estimate extracted | NR | No studies |
Attrition rate Summary of findings ‐ Ketogenic diets vs other ketogenic diets | no estimate extracted | 6 studies · 326 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Ketogenic diet or other dietary treatments for people with epilepsy
Population: people with epilepsy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure freedom 100% Number of people | no estimate extracted | 4 studies · 256 participants | Low Downgraded: imprecision, inconsistency |
Seizure reduction > 50% Number of people | no estimate extracted | 6 studies · 387 participants | Low Downgraded: imprecision, inconsistency |
Adverse effects Number of people | no estimate extracted | 7 studies · 427 participants | Low Downgraded: imprecision, inconsistency |
Attrition rate Number of people | no estimate extracted | 7 studies · 427 participants | Low Downgraded: imprecision, inconsistency |
Ketogenic Diet or other Dietary Treatments for
Population: patients with
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure Reduction > 50% Number of people | no estimate extracted | 4 studies · 247 participants | Low Downgraded: imprecision, inconsistency |
Adverse Effects Number of people | no estimate extracted | 0 studies · 4 participants | Very low Downgraded: imprecision, inconsistency |