{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:08:15Z","timestamp":1784268495542,"version":"3.55.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Epilepsy is a global neurological disorder that contributes to a significant disease burden in children and adolescents. About 11 million children worldwide suffer from epilepsy. Most children with epilepsy respond to anti-epileptic drugs and have controlled symptoms. However, drug-resistant epilepsy (DRE) happens in some children which presents a lot of challenges to their quality of life and development. Alternative treatment for DRE is ketogenic diet therapy (KDT) which is also given alongside the regiment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study aims to compare the prescribed anti-epileptic drug cost of patients receiving KDT compared to the initial pre-diet cost. This study was a descriptive analytical retrospective using outpatient medical records in Dr.Cipto Mangunkusumo General Hospital (RSCM Kiara) from 2021 to 2022. Subjects were patients with drug-resistant epilepsy and underwent a ketogenic diet up to 6 months and aged between 5\u201318 years old. These patients were then evaluated for their anti epileptic drug costs before starting and after they did a ketogenic diet for up to 6 months with cost evaluation at 3 months interval. The cost of prescribed outpatient antiepileptic drugs were adjusted according to prices set by the Indonesian Ministry of Health. Parents of participants were also surveyed about their satisfaction with KDT using Google Form questionnaire with consent prior to survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In this study, a comparison between the overall cost of incorporating KDT for 6 months and pre-diet treatment plan was found to have a statistically significant cost reduction for the incorporation of KDT which demonstrated 21.8% overall reduction in outpatient anti epileptic drug costs among 16 patients which was found to be Rp 3,757,812 or 235 US$ (\n                      <jats:italic>p<\/jats:italic>\n                      = &amp;lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study demonstrated that incorporating KDT for 6 months provides significant financial savings in treatment cost for children with drug-resistant epilepsy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1872749","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:44:25Z","timestamp":1784267065000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of ketogenic diet therapy in outpatient anti epileptic drug cost reduction and parental satisfaction among children with intractable epilepsy"],"prefix":"10.3389","volume":"17","author":[{"given":"Achmad","family":"Rafli","sequence":"first","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Setyo","family":"Handryastuti","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Soebadi","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dara Ninggar","family":"Santoso","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indira","family":"Rahmawati","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Pramana","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahadian","family":"Ramadhan","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford Peter","family":"Anthony","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irawan","family":"Mangunatmadja","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/epi.14458","article-title":"Epilepsy in Asia: disease burden, management barriers, and challenges","volume":"60","author":"Trinka","year":"2019","journal-title":"Epilepsia"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s42494-023-00137-0","article-title":"Biomolecular mechanisms of epileptic seizures and epilepsy: a review","volume":"5","author":"Sumadewi","year":"2023","journal-title":"Acta Epileptol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"663","DOI":"10.3390\/brainsci11050663","article-title":"Mechanisms of drug resistance in the pathogenesis of epilepsy: role of neuroinflammation. A literature review","volume":"11","author":"Bazhanova","year":"2021","journal-title":"Brain Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.seizure.2018.02.002","article-title":"Epidemiological profile of epilepsy in low income populations","volume":"56","author":"Espinosa-Jovel","year":"2018","journal-title":"Seizure"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3390\/jcm8010039","article-title":"Epilepsy in children: from diagnosis to treatment with focus on emergency","volume":"8","author":"Minardi","year":"2019","journal-title":"JCM"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1111\/j.1528-1167.2009.02397.x","article-title":"Definition of drug resistant epilepsy: consensus proposal by the ad hoc task force of the ILAE commission on therapeutic strategies","volume":"51","author":"Kwan","year":"2010","journal-title":"Epilepsia"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"880","DOI":"10.3390\/neurolint16040066","article-title":"Trends in prevalence and incidence of epilepsy and drug-resistant epilepsy in children: a Nationwide population-based study in Korea","volume":"16","author":"Lee","year":"2024","journal-title":"Neurol Int"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e25277","DOI":"10.1097\/MD.0000000000025277","article-title":"Genetic factors and the risk of drug-resistant epilepsy in young children with epilepsy and neurodevelopment disability: a prospective study and updated meta-analysis","volume":"100","author":"Lin","year":"2021","journal-title":"Medicine"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1155\/2023\/9222632","article-title":"The effectiveness of modified Atkins ketogenic diet on children with intractable epilepsy: a pilot study from Indonesia","volume":"2023","author":"Rafli","year":"2023","journal-title":"J Nutr Metab"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1001\/jamapediatrics.2020.2282","article-title":"Efficacy of ketogenic diet, modified Atkins diet, and low glycemic index therapy diet among children with drug-resistant epilepsy: a randomized clinical trial","volume":"174","author":"Sondhi","year":"2020","journal-title":"JAMA Pediatr"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"CD001903","DOI":"10.1002\/14651858.CD001903.pub4","article-title":"Ketogenic diets for drug-resistant epilepsy","volume":"6","author":"Martin-McGill","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1744","DOI":"10.3390\/nu14091744","article-title":"Effects of classic ketogenic diet in children with refractory epilepsy: a retrospective cohort study in Kingdom of Bahrain","volume":"14","author":"Perna","year":"2022","journal-title":"Nutrients"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/s0002-8223(02)90091-x","article-title":"Medical costs are reduced when children with intractable epilepsy are successfully treated with the ketogenic diet","volume":"102","author":"Mandel","year":"2002","journal-title":"J Am Diet Assoc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1111\/epi.13254","article-title":"An economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy: an interim analysis","volume":"57","author":"de Kinderen","year":"2016","journal-title":"Epilepsia"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1111\/epi.13655","article-title":"A systematic review of economic evaluations of treatments for patients with 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treatments for drug-resistant epilepsy: a systematic review","volume":"64","author":"Chan","year":"2023","journal-title":"Epilepsia"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1177\/08830738241227066","article-title":"Ketogenic diet: parental experiences and expectations","volume":"39","author":"Orr","year":"2024","journal-title":"J Child Neurol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"107493","DOI":"10.1016\/j.yebeh.2020.107493","article-title":"Telemedicine, drug-resistant epilepsy, and ketogenic dietary therapies: a patient survey of a pediatric remote-care program during the COVID-19 pandemic","volume":"112","author":"Semprino","year":"2020","journal-title":"Epilepsy Behav"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1872749\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:44:27Z","timestamp":1784267067000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1872749\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":20,"alternative-id":["10.3389\/fneur.2026.1872749"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1872749","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]},"article-number":"1872749"}}