ORIGINAL RESEARCH article
Front. Neurol.
Sec. Epilepsy
Effectiveness, tolerability, and retention of ketogenic diet for Infantile epileptic spasms syndrome: A single-center cohort study
Fen Zhao 1,2
Wandong Hu 2,1
Wenchao Zhang 2,1
Yi Lu 2,1
Hongwei Zhang 2,1
1. Jinan Children's Hospital, Jinan, China
2. Children's Hospital Affiliated to Shandong University, Jinan, China
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Abstract
Objective: To investigate the effectiveness, tolerability and retention of ketogenic diet (KD) in patients with infantile epileptic spasms syndrome (IESS). Methods: In this single-center prospective cohort study, baseline data were collected from Children's Hospital Affiliated to Shandong University. Follow-up assessments were conducted at 3, 6, and 12 months after initiating KD. Outcomes included seizure frequency, adverse reactions, and retention rates. Survival analysis was used to examine the association between retention rate and follow-up duration. Results: A total of 74 patients with IESS were admitted. The seizure response rates were 56.8% (42/74), 41.9% (31/74), and 25.7% (19/74) at 3,6, and12 months, respectively. Corresponding seizure-free rate was 13.5% (10/74), 13.5% (10/74), and 8.1% (8/74). Retention rates at 3, 6, and 12months were 70.2% (52/74), 43.2% (32/74), and 25.7% (19/74), respectively. Survival analysis showed that retention decreased over time, most markedly within the first 3 months. Responders to KD exhibited significantly higher retention rates than non-responders throughout the 12-month period (HR = 0.35, 95% CI: 0.19–0.64; p < 0.001). Adverse reactions were reported in 20.3% of patients, with gastrointestinal symptoms being most common (16.2%), including constipation (6.8%), diarrhea (5.4%), and vomiting (4.0%). Conclusion: KD demonstrated favorable effectiveness and acceptable safety in patients with IESS, particularly those refractory to first-line antiseizure medications (ASMs). The higher retention among responders supports its utility in children with IESS. Early initiation of KD should be considered for IESS patients unresponsive to first-line ASMs.
Summary
Keywords
effectiveness, Infantile epileptic spasms syndrome, Ketogenic Diet, retention, Safety
Received
08 September 2025
Accepted
31 January 2026
Copyright
© 2026 Zhao, Hu, Zhang, Lu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hongwei Zhang
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