This study was conducted on thirty children aged from12 months to 18 years newly diagnosed with drug resistant epilepsy and following up at Pediatric Nutrition and Neurology Outpatient Clinics assigned randomly into 2 groups, group1: patients who started ketogenic diet with L-carnitine and group2: patients who started ketogenic diet only.

Inclusion Criteria:

• All infants and children aged from 12 months to 18 years old newly diagnosed with drug resistant epilepsy and were assigned to start KD.

Exclusion Criteria:

• Patients with intolerance or non-compliance to ketogenic diet therapy.
• Patients for epilepsy surgery or vagal nerve stimulation.
• Children with history of previous abdominal operations.
• Children with history of GI diseases affecting GI motility before starting KD.
• Children with tube feeding or feeding gastrostomy or jejunostomy.