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Background: Ketogenic diet therapy (KDT) has been recommended as a treatment for drug‐resistant epilepsy in children and young people since 2012 in the National Institute for Health and Care Excellence Clinical Guidelines for Epilepsies. The Ketogenic Dietitians Research Network completed a survey in 2017 to assess the impact of these guidelines. Methods: An online survey was circulated to ketogenic dietitians across the UK and Ireland. The results were compared with those of the 2017 survey. Results: The number of individuals following KDT was 854, comprising an increase of 13% since 2017. Service sizes ranged widely, with 1–74 (median 16) patients on the diet. Of 36 services, 30 had a waiting list, ranging from 2 to 67 (median 9) patients. The classical diet continued to be the most common KDT used (58% of patients). Ten services reported use of a new flexible medium chain triglyceride protocol. Some 48% of patients (n = 427) had been following the KDT for over 2 years, comprising an 18% increase since 2017. Of these, 68 (15.9%) had attempted to wean off KDT but had to re‐start as a result of a deterioration in seizures. Conclusions: The number of individuals following medical KDT remains stable. Referral numbers and waiting lists remain high, highlighting that KDT is still a well‐recognised treatment option for drug‐resistant epilepsy. The types of KDT used are similar to previous years, although increasingly flexible protocols are being adopted. Longer‐term use of KDT is increasing, with a proportion of patients requiring long‐term use to maintain seizure control. Highlights: Ketogenic diets remain a well‐recognised treatment option for drug‐resistant epilepsy in the UK and Ireland with the introduction of more flexible protocols in adults and children. [ABSTRACT FROM AUTHOR]

Aim: To investigate the rate of successful withdrawal of antiseizure medication (ASM) after starting the ketogenic diet in children and identify predictive factors. Method: We retrospectively reviewed data of children with epilepsy, who were treated with the ketogenic diet for 6 months or longer at our institution, over a 5‐year period. We defined successful withdrawal of one or more medications as a time period of 3 months or more off this medication without restarting it or starting a new agent. Predictive clinical factors were investigated using binary multivariable logistic regression. Results: Seventy‐one children were included (28 females, 43 males; median age at seizure onset 5 months, median age at diet initiation 58.5 months, median duration of ketogenic diet 27.7 months). Reduction of one or more ASMs was attempted in 54 out of 71 (76%) children and was successful in 34 out of 54 (63%), including discontinuation of all ASMs in 13. Younger age at the start of the ketogenic diet was associated with higher odds of successful ASM withdrawal. ASM withdrawal was successful in 11 out of 19 children with less than 50% seizure reduction at 3 months. Interpretation: Reduction of ASM was achieved in two‐thirds of patients after the start of the ketogenic diet, where attempted, and can be successful even with little or unchanged seizure frequency while on the diet. [ABSTRACT FROM AUTHOR]

Objective: Biochemical assessment is recommended for patients prior to initiating and following a ketogenic diet (KD). There is no published literature regarding current practice in the UK and Ireland. We aimed to explore practice in comparison with international guidelines, determine approximate costs of biochemical testing in KD patients across the UK and Ireland, and promote greater consistency in KD services nationally. Methods: A survey was designed to determine the biochemical tests requested for patients at baseline, 3, 6, 12, 18, and 24 months + on KD. The survey was circulated to 39 centers across the UK and Ireland. Results: Sixteen centers completed the survey. Full blood count, electrolytes, calcium, liver function tests (LFTs), lipid profile, and vitamin D were requested at all centers at baseline, in keeping with international guidelines. Bicarbonate, total protein, and urinalysis were less consistently requested. Magnesium and zinc were requested by all centers, despite not being specifically recommended for pre‐diet evaluation in guidelines. Urea and electrolyte profiles and some LFTs were consistently requested at follow‐up, in accordance with guidelines. Other LFTs and renal tests, full blood count, lipid profile, acylcarnitine profile, selenium, vitamin D, and urinalysis were less consistently requested at follow‐up. The mean costs of the lowest and highest number of tests requested at baseline in our participating centers were £167.54 and £501.93; the mean costs of the lowest and highest number of tests requested at 3‐month follow‐up were £19.17 and £450.06. Significance: Biochemical monitoring of KD patients varies widely across the UK and Ireland and does not fully correspond to international best practice guidelines. With an ongoing drive for cost‐effectiveness within health care, further work is needed to streamline practice while ensuring patient safety. [ABSTRACT FROM AUTHOR]

Ketogenic dietary therapies are an effective treatment option for children with drug-resistant epilepsy. There is an increasing worldwide interest in using these diets to manage adult epilepsy; uncontrolled studies show similar response rates to those in children. Despite this, there are only a few centres with dedicated services for adults. We clearly need controlled studies of this treatment in adults. Here, we aim to familiarise adult neurologists with the evidence base for these diets and give practical advice on starting and maintaining them in adults. [ABSTRACT FROM AUTHOR]

Background: Ketogenic diet therapy (KDT) is a group of high-fat, low-carbohydrate, moderate protein diets that are an effective treatment option for children and young people with drug-resistant epilepsy. However, 45 % of patients referred to start KDT, who are medically eligible to do so, do not start diet. A further 25 % discontinue KDT before 3 months., Aim: To explore barriers and facilitators for children and young people with epilepsy to start or continue on KDT, and their families. Based on the Participants, Concept and Context (PCC) framework, this review included children and young people with drug-resistant epilepsy (P) referred for KDT (C) or their families, who had expressed their views regarding barriers or facilitators for starting or continuing on dietary treatment (C)., Methods: This scoping review followed JBI methodology. Identified barriers/facilitators were matched to relevant sections of the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) model and organised according to the phases of the patient journey: pre-diet, diet initiation and maintenance., Results: 60 studies were included. 15 barriers and 9 facilitators were identified for the pre-diet and initiation stages; 19 barriers and 14 facilitators were identified for staying on KDT once the diet had been fully established., Conclusions: Barriers and facilitators for children and young people who are considering starting KDT, or who are currently following KDT, and their families, are multifactorial and extend beyond the level of the individual. Our findings will help identify areas to prioritise for interventions to support patients and their families., Competing Interests: Conflicts of interest NES was previously supported for a research post by Vitaflo (International). She has received grants from Nutricia Advanced Medical Nutrition, Vitaflo (International) and Matthew's Friends Charity, and honoraria from Nutricia Advanced Medical Nutrition, Vitaflo (International) Ltd and Dr Schaer. LCLN received grants from Nutricia Advanced Medical Nutrition, and Matthew's Friends Charity. HH has no conflicts of interest., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This prospective open-label feasibility study aimed to evaluate acceptability, tolerability and compliance with dietary intervention with K.Vita, a medical food containing a unique ratio of decanoic acid to octanoic acid, in individuals with drug-resistant epilepsy. Adults and children aged 3-18 years with drug-resistant epilepsy took K.Vita daily whilst limiting high-refined sugar food and beverages. K.Vita was introduced incrementally with the aim of achieving ≤35% energy requirements for children or 240 ml for adults. Primary outcome measures were assessed by study completion, participant diary, acceptability questionnaire and K.Vita intake. Reduction in seizures or paroxysmal events was a secondary outcome. 23/35 (66%) children and 18/26 (69%) adults completed the study; completion rates were higher when K.Vita was introduced more gradually. Gastrointestinal disturbances were the primary reason for discontinuation, but symptoms were similar to those reported from ketogenic diets and incidence decreased over time. At least three-quarters of participants/caregivers reported favourably on sensory attributes of K.Vita, such as taste, texture and appearance, and ease of use. Adults achieved a median intake of 240 ml K.Vita, and children 120 ml (19% daily energy). Three children and one adult had ß-hydroxybutyrate >1 mmol/l. There was 50% (95% CI 39-61%) reduction in mean frequency of seizures/events. Reduction in seizures or paroxysmal events correlated significantly with blood concentrations of medium chain fatty acids (C10 and C8) but not ß-hydroxybutyrate. K.Vita was well accepted and tolerated. Side effects were mild and resolved with dietetic support. Individuals who completed the study complied with K.Vita and additional dietary modifications. Dietary intervention had a beneficial effect on frequency of seizures or paroxysmal events, despite absent or very low levels of ketosis. We suggest that K.Vita may be valuable to those with drug-resistant epilepsy, particularly those who cannot tolerate or do not have access to ketogenic diets, and may allow for more liberal dietary intake compared to ketogenic diets, with mechanisms of action perhaps unrelated to ketosis. Further studies of effectiveness of K.Vita are warranted., (© The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain.)

Objective: Biochemical assessment is recommended for patients prior to initiating and following a ketogenic diet (KD). There is no published literature regarding current practice in the UK and Ireland. We aimed to explore practice in comparison with international guidelines, determine approximate costs of biochemical testing in KD patients across the UK and Ireland, and promote greater consistency in KD services nationally., Methods: A survey was designed to determine the biochemical tests requested for patients at baseline, 3, 6, 12, 18, and 24 months + on KD. The survey was circulated to 39 centers across the UK and Ireland., Results: Sixteen centers completed the survey. Full blood count, electrolytes, calcium, liver function tests (LFTs), lipid profile, and vitamin D were requested at all centers at baseline, in keeping with international guidelines. Bicarbonate, total protein, and urinalysis were less consistently requested. Magnesium and zinc were requested by all centers, despite not being specifically recommended for pre-diet evaluation in guidelines. Urea and electrolyte profiles and some LFTs were consistently requested at follow-up, in accordance with guidelines. Other LFTs and renal tests, full blood count, lipid profile, acylcarnitine profile, selenium, vitamin D, and urinalysis were less consistently requested at follow-up. The mean costs of the lowest and highest number of tests requested at baseline in our participating centers were £167.54 and £501.93; the mean costs of the lowest and highest number of tests requested at 3-month follow-up were £19.17 and £450.06., Significance: Biochemical monitoring of KD patients varies widely across the UK and Ireland and does not fully correspond to international best practice guidelines. With an ongoing drive for cost-effectiveness within health care, further work is needed to streamline practice while ensuring patient safety., Competing Interests: Matthew's Friends Charity, Nutricia Advanced Medical Nutrition and Vitaflo (International) Ltd sponsored meetings for KDRN, one of which was used to formulate this project. NES is supported by a research grant from Vitaflo (International) Ltd. KJM‐M received a PhD studentship from Vitaflo (International) Ltd. The remaining authors have no conflicts of interest. No funding is declared. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines., (© 2019 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy.)