Effect of Concurrent Anti-Seizure Medications on the Efficacy of the K…
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S. Sharma, A. Aschner, N. Kabir and E. Donner (2026). Effect of Concurrent Anti-Seizure Medications on the Efficacy of the Ketogenic Diet in Children with Epilepsy. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 1-6. https://doi.org/10.1017/cjn.2026.10620
[Abstract]
RATIONALE: The ketogenic diet (KD) is a well-established therapeutic option for children with non-surgical drug-resistant epilepsy (DRE). The purpose of this study was to determine whether specific anti-seizure medications (ASM) are associated with positive seizure outcomes when used concurrently with KD.
METHODS: This was a retrospective chart review of children with DRE treated with KD at the Hospital for Sick Children from Jan 2011 to Feb 2022. Data included demographics, epilepsy etiology, seizure type, and ASM used. Children with seizure data available for at least 3 months without dose modification were enrolled. Children with ≥50% reduction in seizures from baseline were classified as responders. The effect of ASM on the efficacy of the KD was analyzed using logistic regression with two models: ASM with clinical parameters such as age, etiology, seizure types, and diet type; and the second model with ASM alone.
RESULTS: A total of 127 children (55 boys) were enrolled. In both models, 5 ASMs were found to have a statistically significant positive association with the efficacy of the ketogenic diet - lacosamide (OR 10.261 [95% CI: 1.533-68.671]), vigabatrin (5.582 [1.141-27.312]), lamotrigine (5.004 [1.423-17.601]), topiramate (3.194 [1.064-9.589]), and levetiracetam (2.895 [1.085-7.722]). No ASMs were negatively associated with seizure responder rate in either model.
CONCLUSION: Several ASMs were positively associated with KD efficacy for seizure reduction. Given the observational design and potential confounding, these findings should be interpreted cautiously and support selecting concomitant ASM based on electro-clinical phenotype and tolerability rather than anticipated effects on KD efficacy.
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