To provide an overview of nine studies including six RCTs analyzing dietary therapies in childhood drug resistant epilepsy(DRE) at a tertiary care centre in India over last 12 years.

Our division has been actively involved in evolution of dietary therapy services in DRE, by making them less restrictive, without compromising efficacy: initially ketogenic diet(KD); subsequently Modified Atkins Diet(MAD) and Low Glycemic Index Therapy(LGIT).

Around 1,500 children from infancy to adolescence have received various dietary therapies (indigenous recipes) over last 12 years. 595 children have been enrolled in nine trials: KD(2006),KD 4:1 vs 2.5:1(2008),MAD vs AED(2009), LGIT vs AED(2011),MAD vs KD(2013), KD vs MAD vs LGIT(2016), Daily vs Intermittent LGIT (2018). One RCT evaluating efficacy of indigenous KD in super refractory status epilepticus and another comparing MAD vs LGIT are about to begin enrollment. Role of various biomarkers like PUFA, HbA1c, Beta Hydroxy Butyrate(BHB) and gut microbiota are being evaluated. Caregiver Satisfaction with Dietary Therapy(CSDT) questionnaire and Dietary Therapy Evaluation of Compliance(DTEC) algorithm have been developed. Tele-consultation services for dietary therapies have been initiated.

Although KD is most efficacious among dietary therapies for DRE, MAD and LGIT are other acceptable less restrictive and better tolerated options.