Study population
congenital metabolic disorders, seizures
LIVER DISEASES, SYSTEMIC DISEASE, CHRONIC DISEASES
We initially enrolled forty patients with DRE attending Pediatric KD outpatient clinic at Menoufia University Hospital from January 2020 to April 2022, after obtaining the approval of the Institutional Review Boards of the Menoufia Faculty of Medicine (ID number 191019 PEDI 29) and an informed (written) consent was obtained from each parent or caregiver.Our inclusion criteria were patients who had received two or more types of regular antiepileptic drugs, but frequent seizures continued. Patients with chronic diseases, congenital metabolic disorders, liver diseases, and systemic diseases were excluded from the study.Patients were randomly assigned to two groups, Group 1 (classic KD group): 20 patients received classic KD in the form of formula (Ketocal milk from Danone, Nutricia) and food with the ratio of 3–4 g of fat for every 1 g of carbohydrate and protein, and Group 2 (MAD group): 20 patients kept on MAD consisting of a nearly balanced diet (60% fat, 30% protein, and 10% carbohydrates by weight) providing 100 kcal/kg/day, without restrictions on calories, fluids, protein or need for an inpatient fast and admission.Before starting KD, we collected demographic and clinical data of studied patients including age, sex, age of start of seizures, anthropometric measurements (weight, length/height, weight for length/height, and BMI) according to Egyptian 