This Practice Point commentary discusses the findings of Neal et al.'s randomized controlled trial of the ketogenic diet in children with refractory epilepsies. The authors showed that the ketogenic diet was superior to continuation of medical treatment in reducing seizure frequency in this patient population. On the basis of these and other results I argue three points, the first being supported by the literature and the others being personal opinion. First, the ketogenic diet should be considered for the treatment of children with drug-resistant epilepsy and not only as a last resort. Second, the allocation of resources to support professionals in administering the ketogenic diet is justifiable. Third, we must develop alternative strategies to randomized controlled trials if we wish to obtain timely information on effective treatment strategies for specific pediatric epilepsy syndromes.