{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:18:39Z","timestamp":1789798719914,"version":"4.0.1"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":260,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Pediatrics"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Miller\u2013Dieker syndrome (MDS) is a rare genetic disorder characterized by classical lissencephaly, severe neurodevelopmental impairment, and early\u2010onset drug\u2010resistant epilepsy. Feeding difficulties and aspiration pneumonia significantly contribute to morbidity and mortality. Evidence regarding ketogenic diet (KD) therapy in patients with severe neurological impairment requiring exclusive enteral nutrition is limited. We report the case of an infant with MDS and pharmacoresistant epilepsy complicated by severe feeding intolerance and recurrent aspiration pneumonia. KD was initiated via postpyloric enteral feeding and subsequently administered through percutaneous endoscopic jejunostomy using a low ketogenic ratio (1.25:1). The diet was well tolerated and associated with seizure freedom maintained until the child\u2019s death from an unrelated surgical complication (volvulus), improved nutritional status, and several months of clinical stability. This case highlights the feasibility of enteral KD therapy as part of a multidisciplinary, palliative\u2010oriented approach for managing drug\u2010resistant epilepsy in children with MDS.<\/jats:p>","DOI":"10.1155\/crpe\/8660691","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:53:22Z","timestamp":1789797202000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Managing Drug\u2010Resistant Epilepsy and Severe Feeding Difficulties in Miller\u2013Dieker Syndrome: The Role of Enteral Ketogenic Diet"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1318-7922","authenticated-orcid":false,"given":"Perrone","family":"Michela","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Porro","family":"Matteo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piemontese","family":"Pasqua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2667-4620","authenticated-orcid":false,"given":"Roggero","family":"Paola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gangi","family":"Silvana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumagalli","family":"Monica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02433.x"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nbd.2009.02.008"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci12010056"},{"key":"e_1_2_12_4_2","first-page":"1","article-title":"Understanding the Molecular Basis of Miller\u2013Dieker Syndrome","author":"Brown J. 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