Purpose:To determine the efficacy ,adverse effects and tolerability of MAD in intractable epilepsy of children of different types in Bangladesh.

Methodology: This was a randomized controlled trial done from July 2016 to December 2017. This study was carried out in the OPD of Paediatric Neurology,NINS , OPD of Paediatric Neurology, BSMMU,OPD of Paediatric Neurosciences, DSH of Dhaka.At each of the study sites intractable epilepsy cases aged 3 to 18 years having at least 3 seizures per week who intended to be enrolled were randomized either as in study group (MAD treatment group) and control group (getting normal family diet) by lottery method. Children were evaluated there after through detail history , clinical examination and Laboratory test..The standard anticonvulsant medications were   continued to both the group . After one month observation period MAD was given to the study group and  3 follow up visit at an interval of one month  was made. At the end of the 3-month study period, the average seizures per month in the preceding one month was compared with the average monthly seizure frequency in the baseline period.

Results:. The primary outcome of this study at the endpoint of 3rd follow-up, 71 % children had at least 50% or more seizure reduction and 25.7 % children had a ≥ 90% seizure reduction. Only 8 children in MAD group developed constipation, and other adverse effects were vomiting, skin rash, abdominal pain and abdominal distention..

Conclusion: Results of the study documented that  MAD.was found to be effective in reducing seizure burden in children with refractory epilepsy  as well tolerated in the studied children and  only few adverse effects were observed during study period