Dressler A, et al. - In infants with West syndrome, researchers compared the effectiveness and safety of the ketogenic diet (KD) vs standard adrenocorticotropic hormone (ACTH) treatment. For this investigation, infants were randomized to KD or high-dose ACTH. In this parallel-cohort (PC) randomized controlled trial (RCT), 101 infants were included, with 32 in the RCT (16 KD; 16 ACTH) and 69 in the PC (37 KD; 32 ACTH). In the long term, KD is as effective and better tolerated vs ACTH. Data reported that ACTH is still the first choice for short-term remission with no prior treatment with vigabatrin (VGB). However, KD was at least as effective in the short term with previous VGB vs ACTH and was linked with lower recurrence rates in the long term. It is, therefore, a suitable second-line treatment after VGB. The research should be interpreted cautiously.