Abstract
OBJECTIVE: This study was undertaken to describe weaning practices following ketogenic diet therapy (KDT) in children with epilepsy and to identify clinical factors associated with seizure exacerbation or antiseizure medication adjustments during or after weaning from KDT. METHODS: This retrospective observational study examined patients who initiated and discontinued KDT between 2016 and 2022 at a tertiary epilepsy center. Patients with GLUT1 deficiency, ongoing KDT, or less than 1 year of follow-up postdiscontinuation were excluded. Clinical, electroencephalographic (EEG), magnetic resonance imaging, KDT response, weaning duration, and seizure outcomes were analyzed. Responders were defined by ≥50% seizure reduction. Seizure worsening and/or antiseizure medication (ASM) adjustments during weaning were the primary outcomes. RESULTS: Among 57 evaluable patients, 49% were responders and 25% became seizure-free. During weaning, 62% experienced seizure exacerbation or required ASM modifications. Unfavorable outcomes were significantly associated with shorter KDT duration, shorter weaning periods, higher ASM burden, and abnormal preweaning EEG. Among responders, seizure worsening was not significantly linked to weaning speed alone. At 1 year, seizure freedom was more common in patients who did not experience any issue during the weaning (65% vs. 30%, p = .009). SIGNIFICANCE: Our findings underscore the importance of individualized KDT discontinuation plans based on efficacy, EEG activity, and ASM burden. Although prolonged weaning was more common in responders, weaning duration alone did not predict outcomes. These results highlight the need for prospective studies to define optimal weaning strategies for KDT.