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When Medication Fails, Unlock a New Approach

After two appropriate anti-seizure medications fail, guidelines recommend considering non-drug treatment options including Ketogenic Diet Therapy (KDT)1

KDT with KetoCal, a medical dietary treatment, is an effective, manageable and palatable option for Drug-Resistant Epilepsy (DRE)2

Medication Alone Is Not Always Enough3,4

  • More than 30% of epilepsy patients do not achieve adequate seizure control with anti-seizure medications4
  • Uncontrolled seizures carry serious clinical and quality of life risks6
  • Up to 40% of patients reported anti-seizure medication (ASM) side effects7

After failure of two appropriate anti-seizure medications1, paediatric and adult patients should be considered for non-drug treatment, such as ketogenic diet therapy, assessment. 

Who to refer for Ketogenic Diet Therapy assessment?

Refer patients with DRE after failure of two appropriate anti-seizure medicines; especially in severe or genetic epilepsies in children.1,8

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NICE-recognised epilepsy syndromes and metabolic disorders1,9

  • GLUT1 deficiency syndrome
  • Pyruvate dehydrogenase deficiency (PDHD)
  • Dravet syndrome
  • Doose syndrome
  • Infantile spasms
  • Complex I mitochondrial disorders
  • Treatment emergent adverse events with ASMs (TEAE)

Epilepsy syndromes and conditions with response rates >70% (defined as  >50% seizure reduction)1,9

  • Ohtahara syndrome
  • Angelman syndrome
  • Complex I mitochondrial disorders
  • Tuberous sclerosis complex
  • GLUT1 deficiency
  • PDHD

Acute presentations, clinical situations, and syndromes or conditions where KDT may be valuable1,9

  • Super-refractory status epilepticus
  • Febrile Infection-Related Epilepsy Syndrome (FIRES)
  • Severe / genetic epilepsies
  • Tuberous sclerosis complex

Discuss Ketogenic Diet Therapy as a treatment option with your patients and refer appropriate patients for ketogenic diet assessment.

Where to Refer?

A comprehensive list of ketogenic diet centres in the UK and Europe has been published by the Matthew’s Friends charity on their website and can be accessed here.

Ketogenic Diet Therapy Is Effective10

The effectiveness of KDT has been demonstrated in multiple scientific studies.

A systematic review and meta-analysis in infants with epilepsy demonstrated:

  • Approximately 60% achieved ≥50% seizure reduction10
  • 33% became seizure-free10

Beyond seizure reduction, KDT can lead to improvements in alertness, development, behaviour and overall quality of life10,11,22.

KDT is becoming easier to implement and maintain

Recent advances have made KDT more practical for patients, families and healthcare professionals:

  • Ready-to-use ketogenic formulas
  • More flexible diet options
  • Practical support tools, such as recipe books, online diet management tools, cookery classes

These developments have led to better support for patients, simpler implementation, reduced day-to-day burden and improved adherence2.

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Tools to help you explain Ketogenic Diet Therapy to families

Nutricia has created educational resources in accessible language which explain what ketogenic diet therapy is and how it is managed. Click here to find out more. 

KetoCal, a range of prescribable ketogenic products, supports practical KDT initiation and maintenance

KetoCal stands alone as the only KDT brand with multiple evidence of tolerability and efficacy in seizure and non-seizure related outcomes2, 13-20. KetoCal®’s effectiveness in seizure reduction is supported by over 25 years of research2, over 41 publications21 and evidence from over 1,400 patients worldwide.21 

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KDT with KetoCal shows higher response rates (≥50% seizure reduction) compared with KDT alone²

Adapted from: Carroll JH, et al. Over twenty five years of ketogenic diet therapy: supporting children and adults with drug resistant epilepsy using nutritionally complete ketogenic formulations: a scoping review. Epilepsy Behav. 2025;172:110683. doi:10.1016/j.yebeh.2025.110683

Healthcare professionals can prescribe Nutricia’s comprehensive range of ketogenic medical foods to help make the ketogenic diet easier for adults and children living with epilepsy, and their families. 

Learn more about our prescribable ketogenic products

9 in 10 patients²³ like the taste of KetoCal

In a study with KetoCal LQ 2.5:1, patients reported that KetoCal was easy to use, easy to consume, and easy to incorporate into their daily routine, with 88% liking it overall and 63% agreeing that it made following their ketogenic diet easier.23

We asked* dietitians about the taste of medical ketogenic formulas — and most loved KetoCal.

More than 90% of the dietitians who tasted KetoCal 4:1 LQ and 2.5:1 LQ said they loved it*.

*Non-blinded tasting survey with 107 dietitians done in 2019. Data on file. 91% of dietitians said KetoCal 4:1 was good or very good. 97% of dietitians said KetoCal 2.5:1 was good or very good. 

Patient support services

In addition to our products, we help families start and stay on KDT through:

  • cookery classes
  • 1:1 cookery demonstrations
  • bespoke recipe books
  • online diet management tools.

Learn more about the additional services we offer patients and families here. 

KDT can significantly improve outcomes for patients with drug-resistant epilepsy2,22

Tia suffered from infantile spasms and endured hundreds of seizures daily until ketogenic diet therapy helped her achieve her first seizure-free day just six weeks after starting treatment—watch her inspiring story below.

The Ketocal Range are Foods for Special Medical Purposes for the dietary management of drug-resistant epilepsy or other medical conditions where the ketogenic diet is indicated and must be used under medical supervision. 

  1. Kossoff E, et al. Epilepsia Open.2018 May 21;3(2):175–92.
  2. Carroll JH, Simpson Z, Healy L, Szwec C, Hofman DL. Over twenty five years of ketogenic diet therapy: supporting children and adults with drug resistant epilepsy using nutritionally complete ketogenic formulations: a scoping review. Epilepsy Behav. 2025;172:110683. doi:10.1016/j.yebeh.2025.110683
  3. Perucca E, et al. The Lancet Neurology. 2023;22:723–34.
  4. Kwan P, et al. N Engl J Med. 2000;342:314–9.
  5. World Health Organisation (WHO) (2024) http://www.who.int/news-room/fact-sheets/detail/epilepsy.
  6. Sperling MR. The consequences of uncontrolled epilepsy. CNS Spectr. 2004 Feb;9(2):98–101, 106–9.
  7. Zelano J, et al. Seizure - European Journal of Epilepsy. 2023;113:23–7.
  8. Kossoff et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009;50(2):304–317
  9. https://www.nice.org.uk/guidance/ng217/chapter/8-Non-pharmacological-treatments
  10. Lyons L et al. Use of ketogenic diet therapy in infants with epilepsy: A systematic review and meta-analysis. Epilepsia. 2020;61:1261–1281
  11. Nerurkar LJ,Buttle J,Symonds S,M Zuberi,A. Brunklaus. The ketogenic diet in drug-resistant epilepsy of early childhood (<3 years): Indications, tolerability and outcomes. Developmental Medicine and Child Neurology. 2019;61:45
  12. Thompson L, Fecske E, Salim M, et al. Use of the ketogenic diet in the neonatal intensive care unit-Safety and tolerability. Epilepsia. 2017;58:e36–e39
  13. Le Pichon J-B, et al. Seizure. 2019;69:41–3.
  14. De Brito Sampaio LP, et al. Arq Neuropsiquiatr. 2017;75 (04):234–7.
  15. Pires ME, et al. Epilepsy Res. 2013;105(1–2):189–94.
  16. Karimzadeh P, et al. Iran J Child Neurol. 2019;13(4):83.
  17. Ashrafi MR, et al. Acta Neurol Belg. 2017;117:175–82.
  18. El-Rashidy O, et al. Acta Neurol Scand. 2013;128(6):402–8.
  19. Dressler A, et al. Epilepsy Res. 2015;116:53–8.
  20. El-Shafie AM, et al. Pediatr Res. 2023;94(6):1978–89.
  21. Data on file, 2026
  22. Berkel AA, Ijff DM, Verkuyl JM. Cognitive benefits of the ketogenic diet in patients with epilepsy: A systematic overview. Epilepsy Behav. 2018;87:69-77
  23. Griffen, Corbin, et al. "Tolerance, adherence, and acceptability of a ketogenic 2.5: 1 ratio, nutritionally complete, medium chain triglyceride-containing liquid feed in children and adults with drug-resistant epilepsy following a ketogenic diet." Epilepsia open 9.2 (2024):727-738.
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