Wyv-- I don't doubt the diet might be a better choice in some cases. It comes down to weighing the potential risks of the drug against the benefits for EACH INDIVIDUAL child. For example, my son happened to be underweight and very small for his age already. Would I want to make dietary changes that could cause him to lose MORE weight or grow even slower? No. We were also able to control his seizures with a relatively low dose of medication, twice daily, which had the added "side effect" of actually stimulating his appetite. Combined with healthy food choices, and the flexibility of diet to allow for him to eat a wider variety of foods, he's in robust health. We monitor his liver and kidney function, and so far, we've had absolutely no adverse effects. If it ever starts to show anything else, you can bet changes will be made.