A retrospective observational study of 58 pediatric patients with drug‑resistant epilepsy compared 29 children on a ketogenic diet with 29 receiving standard care. The diet was associated with an 83% reduction in seizure frequency, markedly fewer hospitalizations and neurologist visits, and a projected ten‑year direct medical cost reduction of about 130,000 RUB after accounting for diet expenses.
Study and findings
The authors performed a single‑center, retrospective, non‑interventional analysis of children with drug‑resistant epilepsy (DRE). Fifty‑eight patients were included; 29 received a classical ketogenic diet (KD) and 29 served as a contemporaneous comparison group receiving usual care without KD. Over a two‑year observation period, seizure frequency, number of hospitalizations, and outpatient neurologist consultations were recorded. The KD group experienced an average 83 % decline in seizure count relative to each child's baseline (p = 0.037) and a 78 % lower seizure count than the comparison group (p = 0.013). Hospitalizations averaged 2.70 ± 3.22 per child in the KD cohort versus 10.14 ± 7.79 in controls (p = 0.0001). Neurologist visits were also significantly fewer (p = 0.00001). Using these utilization data, the authors modelled direct medical costs (DMCs) over a ten‑year horizon. Excluding the cost of the diet, projected DMCs were 3.05‑fold lower with KD. When diet expenses were included, total DMCs remained approximately 130 000 RUB lower than in the non‑KD group. Antiepileptic drug costs contributed only 15 % of overall DMCs.
Clinical interpretation
The observed seizure reduction aligns with the known anticonvulsant effect of sustained ketosis, suggesting that KD can achieve meaningful seizure control in a substantial proportion of pediatric DRE patients. The pronounced decrease in hospital admissions and specialist visits indicates that improved seizure control translates into reduced acute care needs, which is a key driver of health‑care expenditure in this population. Although the cost model shows a net saving after accounting for the diet, the magnitude of the saving depends on local price structures and the duration of diet adherence, which was not detailed in the report. The modest share of drug costs within total DMCs underscores that medication burden is not the primary cost determinant in severe pediatric epilepsy.
Limitations and open questions
The study’s retrospective design precludes causal inference; unmeasured confounders such as differences in baseline seizure severity or concomitant therapies could influence outcomes. The sample size is modest and drawn from a single specialized center, limiting generalisability to other health‑system contexts. Duration of KD exposure and adherence rates were not reported, preventing assessment of the relationship between ketosis depth and clinical or economic effects. The cost analysis relies on a modelling approach rather than actual longitudinal cost data, and it excludes indirect costs (e.g., caregiver productivity loss). Future prospective, multicentre trials with predefined economic endpoints and detailed adherence monitoring are needed to confirm whether the KD consistently yields cost‑effective seizure control across diverse settings.
Source
Lukyanova EG, Tolkushin AG, Ayvazyan SO, Osipova KV, Pyrieva EA, Krapivkin AI, et al. [Ketogenic diet in the treatment of drug-resistant epilepsy in children: Assessment of clinical efficacy, health care resource consumption, and direct medical costs]. Zh Nevrol Psikhiatr Im S S Korsakova. 2026;126(8):86-95. doi: 10.17116/jnevro202612608186. PMID: 42676204.