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Predicting the efficacy of classic ketogenic diet therapy in children with refractory epilepsy using dynamic changes

Jiang Li1, Tianqi Wang2, Lifei Yu2

  • 1Department of Neonatology, Changsha Hospital for Maternal & Child Health Care Affiliated to Hunan Normal University, Changsha, China.

Seizure
|July 14, 2026
PubMed

Insights

A high glucose-ketone index (GKI) on the first day of the classic ketogenic diet (CKD) may predict poor seizure control in children with refractory epilepsy. Monitoring GKI and ketones early can help adjust treatment strategies.

Area of Science:

  • Metabolic Disorders
  • Pediatric Neurology
  • Nutritional Ketosis

Background:

  • Refractory epilepsy in children poses significant treatment challenges.
  • The classic ketogenic diet (CKD) is an established therapy for drug-resistant epilepsy.
  • Predicting CKD efficacy early is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To evaluate the predictive value of dynamic changes in blood glucose, ketones, and the glucose-ketone index (GKI) for CKD efficacy in pediatric refractory epilepsy.
  • To identify early metabolic indicators of treatment response.

Main Methods:

  • Retrospective analysis of 189 children with refractory epilepsy on CKD.
  • Monitoring of blood glucose, blood ketones, and GKI at multiple time points during early CKD treatment.
  • Classification of patients into responders and non-responders based on seizure reduction (Engel's classification) after three months.
  • Receiver operating characteristic (ROC) analysis to determine optimal GKI thresholds.

Main Results:

  • A GKI > 9.63 on day one of CKD therapy was the best single predictor of efficacy (AUC = 0.638).
  • Combining low blood glucose (<4.95 mmol/L) and high blood ketone (>0.75 mmol/L) levels improved predictive performance (AUC = 0.661).
  • The initial phase of CKD (carbohydrate reduction to diet initiation) is a critical metabolic transition window.

Conclusions:

  • An elevated GKI (>9.63) on the first day of CKD may indicate a poor treatment response.
  • Early monitoring of metabolic parameters, particularly GKI and ketone levels, is vital.
  • Timely adjustments to intervention strategies can be facilitated by monitoring these dynamic changes.
Abstract

Keywords:
Blood ketoneCKDChildren with refractory epilepsyClassic ketogenic dietEfficacy predictionGKI

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