Prezioso G, et al. - The authors performed this systematic review to gather and examine all the RCTs and observational studies investigating the efficacy of ketogenic diet (KD) in infantile spasms (IS) patients after a 1- to 6-month follow-up period, in terms of decrease in seizure frequency of >50% or a seizure-free interval. Furthermore, this study examined the potential effect of gender, IS etiology, age at onset of IS, and age at start of KD. It also evaluated the seizure-free rate at 12 and 24 months of follow-up. The present study suggested a potential benefit of KD for drug-resistant IS patients although the literature was still lacking in high-quality studies, which could provide a stronger level evidence.

• The authors performed a computer search on MedLine (PubMed), EMBASE, and the Cochrane Library in June 2016.
• They selected English language studies conducted after 1980 only and those reporting in detail the variation in seizure frequency.

• The authors included 13 observational studies (341 patients) in the final analysis.
• In this study, a median rate of 64.7% of patients experienced a spasm reduction >50% (IQR: 38.94%) and the median spasm-free rate was 34.61% (IQR: 37.94%).
• IS of unknown etiology appeared to have an increased possibility of achieving freedom from seizures (RR: 1.72, 95%CI: 1.18-2.53).
• Long-time follow-up data showed a median seizure-free rate of 9.54% (IQR: 18.23%).