Ketogenic Diet for Epilepsy Control and Enhanced Adaptive Behavior

The current study included all patients following the Pediatric Keto Clinic, Children’s Hospital ASU since it began in 2013. These patients were recruited according to clinic protocol and received KD therapy.

Regarding the frequency of patient complaints and complications, the main causes were gastrointestinal troubles and food refusal and unavailability.We agree with Jagadish et al.¹⁹ He studied 59 children with KD and epilepsy and found that side effects included vomiting in 24% of patients and refusal to eat in 11%.

Regarding the frequency of seizures, a significant decrease was seen after 3 months of KD, and a highly significant decrease after 24 and 36 months. This is consistent with Armeno et al.²⁰ We studied 45 patients with KD and found that 73% of them responded after only 3 months of KD. On the other hand, Jagadish et al.¹⁹ We initially reported a response rate of 63% at the end of the first month of the study series, but this number gradually declined to 41% by the end of the second year of treatment.

Applying the Chalfont seizure severity scale to patients significantly reduced seizure severity after KD. A similar finding was reported by Hallböök and his collaborators^{twenty one} A 12-month study of 18 children with KD diagnosed with DRE found significant improvement in seizure severity at 3 and 12 months. The latter authors primarily attributed their findings to a reduction in the duration of seizures.

Vineland test results in a series of study patients showed that 65% of them showed a significant increase after the use of KD.Similarly, in 2001 Pulsipher and collaborators^{twenty two} used the Child Behavior Checklist to assess behavioral and emotional problems in 65 pediatric patients with DRE after 1 year of KD treatment and found a statistically significant improvement (p < 0.05 ) and showed significant behavioral improvements in attention and social functioning.In addition, Garcias Peñas^Fivethe positive neurocognitive and behavioral effects of KD in pediatric patients with epilepsy were most evident in aspects of mood, alertness and activity levels, sustained attention, and reciprocal social interaction, with seizure control or dose reduction or number of antiepileptic drugs.

From another angle, Wu and collaborators in 2016^{twenty three}, reported a positive correlation between increased cognition and efficacy of KD after 3 months. This is consistent with van Berkel et al.^{twenty four}conducted a systematic overview and reported that cognitive improvements were frequently reported during KD treatment in the domains of alertness, attention, and global cognition. The latter author added that studies using objective neuropsychological tests confirmed effects on attention, but not on global cognition. About van Berkel and Associates^{twenty four} They reported that it was caused by both seizure reduction and a direct effect of KD on cognition.

In the current study, 11% of patients remained on KD for 1 month or less, 25% of patients continued on KD for 1-3 months, 18% continued on KD for 3-6 months, and 13% continued on KD for 6 months. Stayed on KD for ~12 months. Twenty percent remained on KD for 12-24 months, and 13% remained on KD for 24 months or longer. Sharma et al.^{twenty five} Similarly, those who studied 27 Indian children with epilepsy reported that 37% continued to have KD after 1 year.

Regarding the patient’s lipid profile, there were no significant differences in any of its components after KD treatment. This is consistent with a Danish study conducted by Miranda et al.²⁶ No significant increases in free cholesterol, triglycerides, LDL and HDL cholesterol were found when patients with refractory epilepsy received MAD.Even so, Chen²⁷Forty-seven children with intractable epilepsy were studied.In addition, HDL levels were slightly lower and LDL levels were significantly higher after KD treatment.

Patient weight assessment showed a significant increase in body weight, z-score for body weight. On the other hand, Neal et al.⁹ found that body weight z-scores were significantly reduced between baseline and 3, 6, and 12 months of KD therapy in a series of children with intractable epilepsy. This was mostly due to her KD’s calorie restriction.Weight loss was previously documented by Sirven and collaborators²⁸ A study of 11 patients with intractable epilepsy on KD revealed weight loss in 5 patients after 8 months on KD.Weight loss may be the result of decreased calorie intake or increased satiety effect of protein²⁹.

Current patient height/length assessment showed a significant increase in z-score for that value and age.This agrees with Vining and co-workers³⁰ who reported that their child grew taller during the first year of KD. In contrast, Tagliabue et al.³¹ studied 18 children with intractable epilepsy and found no significant difference in height after 6 months of KD.⁹ found that height z-scores showed no change at 3 months but decreased significantly at 6 and 12 months.

One suggested explanation for the improvement in anthropometric values ​​in the series of patients studied was that they were initially malnourished due to socioeconomic causes and that KD provided This may be due to the improved caloric and micronutrient intake when Well in their anthropometry.It is worth noting here that Armeno and his collaborators²⁰ After 4 months of KD therapy, slowed growth was seen in 4 patients (9%) and nutritional status was maintained or even improved at follow-up.

With respect to BMI, the study series of patients showed no significant increase in BMI and z-score BMI with age, which can be explained by proportional increases in weight and height. This is consistent with Perna and coworkers.³² No significant changes in BMI were seen after 12 months of KD use in the 24 children studied.

In conclusion, enrollment of ketoclinic patient data using a software program helped identify characteristics of KD patients, highlighting factors that hinder compliance and warrant promising management outcomes. Data from ASU Children’s Hospital Ketoclinic further demonstrate that KD is an effective treatment for DRE, significantly improving cramp frequency and severity without affecting growth parameters or laboratory results. I’m here. Finally, the enhancement of adaptive behavior is a promising finding, and perhaps with larger studies and longer duration of her KD use, further cognitive benefits in treated patients could be demonstrated.

Research limitations

This study has its own limitations. More patients should have had the Vineland test for adaptive behavior assessment, and more tests to show cognitive benefit have completed the picture.