In addition to showing high levels of efficacy,
similar to many AEDs, the dietary interventions are
generally quite tolerable, can have associated posi-tive effects such as weight loss,
80
and demonstrate
effectiveness in a relatively short time period. Whilst
AEDs may take several weeks to be titrated up to a
therapeutic dose and VNS may take months or years
to show an optimal effect,
81
the effects of a ketogenic
diet can be seen within a few days. Furthermore, the
diets are cost effective compared to many AEDs.
64
In practice, a median of 5 AEDs are prescribed before
considering a metabolic treatment such as the keto-genic diet.
82
Furthermore, 60% of child neurologists
only use a ketogenic diet as a last resort treatment.
83
It is therefore suggested that the metabolic treatments
should be considered earlier in the course of treat-ment, especially in patients with refractory seizures
who are not suitable for or willing to undergo resec-tive surgery.