Implications of the KIWE trial for low-income and lower-middle-income countries

Document Type



Paediatrics and Child Health (East Africa)


We read with interest the Article reporting findings of the KIWE trial,1 which compared the ketogenic diet with antiseizure medications in infants with drug-resistant epilepsy. The trial did not show a significant difference between diet and medication in terms of efficacy and tolerability; however, we wish to highlight several concerns.

Given that 50% of the study cohort had infantile epileptic spasms syndrome (IESS), we trust that the findings are relevant to management practices of patients with IESS in lowincome and lower-middle-income countries.2 The trial found a low clinical response in infants on the ketogenic diet in terms of achieving seizure freedom at 8 weeks.1 However, in this era of precision medicine, characterisation of the electroclinical syndrome and the underlying cause or genetic diagnosis in the children who became seizure-free in both groups would be crucial for a better understanding of these findings.3 Electroclinical remission is a key aim in treating IESS, while a clinical response to either the ketogenic diet or antiseizure medications might be an over-representation of efficacy.

Publication (Name of Journal)

The Lancet Neurology