Researchers tested three different treatments for children whose seizures don’t respond well to regular medicines. One group tried a special high-fat, low-carb diet called the ketogenic diet. Another group took a medicine called lacosamide. A third group did both treatments together. After six months, the kids who combined both treatments had the best results—their seizures decreased more, their brain activity improved on tests, and their thinking and memory got better. This study suggests that using two treatments at the same time might work better than using just one.

The Quick Take

  • What they studied: Whether combining a special diet with a seizure medicine works better than using either treatment alone for children whose seizures don’t respond to regular medications.
  • Who participated: 90 children with hard-to-control epilepsy were split into three equal groups of 30. Each group received a different treatment approach over six months.
  • Key finding: Children who used both the ketogenic diet and lacosamide together had the best results: 77% had major reductions in abnormal brain activity patterns, 63% had simpler seizure types, and their thinking and memory improved more than the other groups.
  • What it means for you: If you have a child with seizures that don’t respond to standard medicines, combining a special diet with this particular medication may be worth discussing with your doctor. However, this is one study, and more research is needed before making treatment decisions.

The Research Details

This was a controlled study where researchers divided 90 children with hard-to-control seizures into three equal groups of 30 children each. One group followed a ketogenic diet (a high-fat, low-carbohydrate eating plan). Another group took a medicine called lacosamide. The third group did both the diet and took the medicine together. The researchers measured how well each treatment worked by checking seizure frequency, brain wave patterns using EEG machines, memory and attention skills, blood fat levels, and blood vessel health. They took these measurements at the start, after three months, and after six months to see how things changed over time.

This approach is important because many children with epilepsy don’t get better with standard seizure medicines alone. By testing a combination of treatments—diet plus medicine—researchers can find better ways to help these children. Measuring multiple things (seizures, brain activity, thinking skills, and blood health) gives a complete picture of whether the treatment actually helps the whole child, not just reducing seizures.

This study was published in a respected medical journal and included careful measurements at multiple time points. The researchers tracked specific, measurable outcomes like EEG patterns and cognitive tests rather than just asking if seizures improved. However, the study included only 90 children total, which is a moderate size. The study doesn’t mention whether it was blinded (where doctors don’t know which treatment patients received), which could affect results. More research with larger groups would strengthen these findings.

What the Results Show

The combination group (diet plus medicine) showed the strongest improvement in seizure control. After six months, children in the combination group had significantly greater seizure reduction compared to either treatment alone. Specifically, about 77% of children in the combination group showed at least a 50% reduction in abnormal brain activity patterns on their EEG tests, compared to lower percentages in the other groups. Additionally, 63% of children in the combination group experienced a simplification of their seizure types—meaning their seizures became less complex and varied. Brain wave patterns also improved more in the combination group, with better activity in multiple frequency bands that are important for normal brain function. These improvements were measured objectively using EEG machines, not just parent or doctor observations.

Beyond seizure control, children in the combination group also showed improvements in thinking and memory skills. Their attention and memory test scores improved more than children in the other groups. The combination therapy also improved blood fat levels (lipid profiles), which is important for heart and brain health. Additionally, markers of blood vessel health improved in the combination group, suggesting the treatment may protect the body’s circulation system. These secondary benefits are important because children with hard-to-control seizures often have other health concerns beyond just seizure frequency.

Previous research has shown that the ketogenic diet can help some children with hard-to-control seizures, and lacosamide is a newer seizure medicine that works differently than older medications. This study builds on that knowledge by testing whether combining these two approaches works better than either alone. The finding that combination therapy outperforms single treatments aligns with a growing trend in medicine toward using multiple approaches together for complex conditions. However, this is one of the first studies specifically looking at this particular combination in children.

The study included only 90 children, which is a moderate sample size. It’s unclear if the study was blinded, meaning doctors and families knew which treatment each child received, which could influence how they reported results. The study lasted only six months, so we don’t know if benefits continue, decrease, or change over longer periods. The study doesn’t describe how the children were selected or whether they were similar in important ways before treatment started. Additionally, the ketogenic diet requires significant family commitment and lifestyle changes, which may be difficult for some families to maintain long-term.

The Bottom Line

For children with seizures that don’t respond to standard medications, discussing combination therapy (ketogenic diet plus lacosamide) with a neurologist may be worthwhile. This approach shows promise based on this research, but it should only be pursued under close medical supervision. The ketogenic diet requires careful planning with a dietitian to ensure proper nutrition. Lacosamide dosing must be managed by a doctor. Moderate confidence: This is one study with positive results, but larger studies would increase confidence in these recommendations.

This research is most relevant for families of children diagnosed with refractory epilepsy (seizures that don’t respond to standard medicines). It may also interest neurologists and pediatricians who treat children with difficult-to-control seizures. This research is NOT a substitute for personalized medical advice. Children with other medical conditions, dietary restrictions, or those taking other medications may not be suitable candidates for this approach. Pregnant adolescents or those planning pregnancy should discuss the ketogenic diet’s effects with their doctor.

Based on this study, improvements in seizure control appeared within three months, with greater improvements by six months. Cognitive improvements (thinking and memory) also developed over this timeframe. However, individual children may respond differently. Some may improve faster, while others may need longer to see benefits. The ketogenic diet requires an adjustment period, typically 2-4 weeks, before seizure improvements appear.

Want to Apply This Research?

  • Track daily seizure count, type, and duration. Additionally, monitor weekly cognitive performance through simple attention or memory games built into the app. Record weekly blood work results (lipid panels) if available. Track dietary adherence to the ketogenic diet by logging meals and macro ratios.
  • Users can set daily reminders for medication timing and dietary meal planning. The app could provide a ketogenic diet meal planner with approved foods and recipes. Users can log seizure episodes immediately after they occur with details about triggers, time of day, and duration. Weekly check-ins can assess mood, energy levels, and any side effects from treatment.
  • Establish a baseline of current seizure frequency before starting treatment. Create a dashboard showing seizure trends over weeks and months. Set milestone goals (e.g., 50% seizure reduction by month 3). Monthly reviews comparing current status to baseline. Automated alerts if seizure frequency increases or medication adherence drops. Share data with healthcare provider through secure export features for clinical appointments.

This research summary is for educational purposes only and should not replace professional medical advice. The ketogenic diet and lacosamide are serious medical interventions that require supervision by a qualified neurologist or pediatrician. Do not start, stop, or change any seizure medications or diets without consulting your child’s doctor first. Individual results vary, and what works for one child may not work for another. This study involved 90 children over six months; longer-term effects are unknown. Parents should discuss all treatment options, potential side effects, and risks with their healthcare team before making decisions.