Discover how ketogenic diet therapy can reduce seizures in children with drug-resistant epilepsy.

Published: November 17, 2025

Estimated reading time: 6 minutes

If your child has epilepsy that doesn’t respond well to medication, you may feel like you’ve run out of options. But there’s hope in an unexpected place: the foods your child eats. Alternative epilepsy treatments for children have come a long way, and dietary therapy has emerged as a powerful tool for managing seizures, especially in children with drug-resistant epilepsy, also called intractable or refractory epilepsy.

Understanding dietary approaches for drug-resistant epilepsy treatment

For decades, health care professionals have recognized that specific diets can significantly reduce seizures in children with epilepsy. These aren’t fad diets or temporary fixes – they’re evidence-based epilepsy treatments that work by changing how the body produces energy.

Many foods contain carbohydrates, or carbs, including sugar, fruit, vegetables, fiber, pasta, rice, bread and beans. Carbohydrates are an energy source for the body. They are one of three macronutrients of the human diet, along with protein and fat. Ketogenic diets shift the body’s main energy source from carbohydrates to fats. This shift may reduce or eliminate seizures for certain patients.

Three of the main ketogenic dietary approaches to treating intractable epilepsy are:

• Classical ketogenic diet (classic KD): A strict, high-fat diet that in which the macronutrients in each meal are measured to meet a certain ratio of fat to protein plus carbohydrate
• Modified Atkins diet (MAD): A less restrictive version of KD in which there is a total daily carbohydrate goal, rather than measuring each meal
• Low glycemic index treatment (LGIT): Focuses on foods that don’t cause rapid blood sugar spikes

All three diets share a common principle: They’re high in fat while limiting carbohydrate intake. This shift in nutrition causes the body to enter a metabolic state called ketosis, where it burns fat instead of glucose for fuel. For reasons researchers are still working to fully understand, this metabolic change can reduce seizure activity in the brain.

What the research shows

A study on diet and intractable epilepsy, published in the journal Epilepsia Open, showed that ketogenic diets have been recognized as proven, effective treatments. Studies consistently showed that nearly half of children on ketogenic diets experience a 50% reduction in their seizures. For certain conditions or types of epilepsy, such as children with Dravet syndrome, infantile spasms and epilepsy with myoclonic-atonic seizures, success rates are even higher.

Leading epilepsy experts from around the world recommend that families consider dietary therapy after trying just two seizure medications that haven’t worked. The research also shows these diets can offer benefits beyond seizure control. Many families report that their children may be able to reduce the number of medications they’re taking, and some children show improvements in thinking and learning.

Ketogenic diet vs. modified Atkins: What’s the difference?

The classic ketogenic diet is the most restrictive option. It typically requires:

• Precise measurement and weighing of all foods
• A specific ratio of fats to carbs plus proteins (usually between 1:1 and 4:1)
• Careful meal planning with guidance from a dietitian
• Regular monitoring of ketone levels in the blood or urine
• Often initiated in a hospital setting

The modified Atkins diet offers more flexibility:

• No need to weigh food
• Less strict carb limits (usually 10 to 20 grams per day to start)
• More protein is allowed
• Families are able to start this diet at home, under close guidance from a ketogenic diet trained doctor and dietician

The low glycemic index treatment is the most flexible:

• Focuses on carbs that digest slowly
• Allows 40 to 60 grams of carbs per day
• May be easier for older children and teenagers to follow

The modified Atkins diet has become increasingly popular because it’s less restrictive for children while still providing significant seizure control. Many families find it more sustainable for long-term use, which is crucial since dietary therapy often needs to continue for months or years.

Is dietary therapy right for your child?

These diets have shown particular promise for children with drug-resistant epilepsy: those who have tried two or more antiseizure medications and are not yet seizure-free. However, these diets also can be considered earlier for children with certain epilepsy syndromes or those whose families prefer to explore nonmedication options. Ketogenic diets often are used in combination with antiseizure medications.

It’s essential to understand that these are medical treatments, not lifestyle choices you should attempt on your own. Both the ketogenic diet and modified Atkins diet must be used at the direction of a physician, along with close supervision from a specialized dietitian. Starting these diets requires medical evaluation, baseline testing and careful monitoring to ensure your child stays healthy while achieving the best possible seizure control.

Important considerations

While dietary therapy offers tremendous potential, it’s not without challenges. Sticking to these diets requires commitment from the whole family. Common hurdles include:

• Initial adjustment period: Some children experience temporary side effects, such as fatigue, constipation or nausea, when starting the diet
• Social situations: Birthday parties, school lunches and eating at restaurants require extra planning
• Meal preparation: Especially with the classic ketogenic diet, preparing meals takes time and precision
• Family involvement: Everyone in the household may need to adjust to support the child’s dietary needs

However, many families find that the benefits far outweigh these challenges, particularly when they see their child’s seizures decrease or stop entirely.

Taking the next step

If you’re interested in exploring dietary therapy as an alternative epilepsy treatment for your child, the first step is talking with your child’s neurologist or epileptologist. They can help determine whether your child is a good candidate and refer you to a specialist at Norton Children’s Neuroscience Institute with experience in implementing these diets.

Questions to ask your doctor include:

• Would my child benefit from dietary therapy based on their seizure type and history?
• Which diet approach would be most appropriate for our family?
• What kind of monitoring and follow-up would be required?
• Are there any specific risks for my child based on their medical history?
• Can you refer us to a dietitian who specializes in epilepsy diets?

Many parents feel overwhelmed when medications don’t provide adequate seizure control. Dietary therapy represents a genuine alternative that has helped thousands of children live fuller lives with fewer seizures. With proper medical guidance and your family’s commitment, these evidence-based nutritional approaches could make a meaningful difference in your child’s epilepsy journey.