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. 2025 Jun;10(3):866-879.
doi: 10.1002/epi4.70048. Epub 2025 May 5.

Knowledge, attitudes, and practices of epilepsy patients regarding the ketogenic diet therapy: A cross-sectional study

Xiuping Zhang  1   2 , Meizhen Sun  3 , Guofang Xue  1 , Yongxiong Zhao  1 , Taotao Du  4 , Xueying Guan  2 , Yong Xu  2   5   6
Affiliations

Knowledge, attitudes, and practices of epilepsy patients regarding the ketogenic diet therapy: A cross-sectional study

Xiuping Zhang et al. Epilepsia Open. 2025 Jun.

Abstract

Objective: The therapeutic ketogenic diet is typically used in epilepsy treatments, yet there has been insufficient understanding regarding the knowledge, attitudes, and practices (KAP) of epilepsy patients concerning this dietary therapy. This study aims to investigate the KAP of epilepsy patients regarding ketogenic diet therapy, with the goal of identifying gaps in knowledge and attitudes that may impact clinical outcomes.

Method: A cross-sectional study was conducted between November 2023 and December 2023 at three epilepsy centers in Shanxi Province: the First Hospital of Shanxi Medical University, the Second Hospital of Shanxi Medical University, and Taiyuan Epilepsy Hospital. Data, including demographic characteristics and KAP scores, were collected via online questionnaires, yielding a total of 612 valid responses, with 320 (52.29%) males.

Results: The mean KAP scores were calculated as follows: knowledge score 4.99 ± 6.72 (possible range: 0-24), attitude score 24.82 ± 2.34 (possible range: 8-40), and practice score 29.48 ± 8.49 (possible range: 9-45). Multivariate analysis revealed that the attitude score (OR = 1.443, 95% CI: [1.296-1.607], p < 0.001) and an epilepsy duration of 5-10 years (OR = 3.086, 95% CI: [1.716-5.548], p < 0.001) were independently associated with positive practice. Additionally, Structural Equation Modeling indicated that knowledge (β = 0.034, p = 0.012) and attitude (β = 0.583, p = 0.010) directly influenced practice, while knowledge also directly affected attitude (β = 0.565, p = 0.013), with an indirect effect on practice through attitude (β = 0.329, p = 0.009).

Significance: The study found insufficient knowledge, suboptimal attitudes, and negative practices toward the ketogenic diet among epilepsy patients. This underscores the need for targeted educational interventions to enhance patient engagement and optimize clinical outcomes.

Plain language summary: This study looked at how much epilepsy patients know about, feel about, and use the ketogenic diet as a treatment. We found that patients generally know little about the diet, have mixed feelings, and do not use it much. Better understanding and positive attitudes were linked to better use of the diet. The results suggest that more education could help patients use the diet more effectively, which might improve their health outcomes.

Keywords: attitudes; epilepsy; ketogenic diet; knowledge; practices.

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Conflict of interest statement

None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

FIGURE 1
FIGURE 1
The prevalence of underlying diseases in the surveyed population.
FIGURE 2
FIGURE 2
Distribution of knowledge across different subgroups.
FIGURE 3
FIGURE 3
Acceptance of ketogenic diet therapy in the surveyed population. The darker the color, the higher the acceptance on a scale of 1–10.
FIGURE 4
FIGURE 4
Structural equation model of knowledge, attitude, and practice.
See this image and copyright information in PMC

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