Examination of the Ketogenic Diet on Seizure and Non-Seizure Symptom Improvements in Pediatric Epilepsy Patients

The ketogenic diet (KD) is an alternative treatment option for patients with refractory epilepsy. The dietary therapy community has defined diet efficacy as a 50% or greater reduction in seizures, with about 50% of patients usually reporting benefit. The aim of this study was to examine KD efficacy within its current definition (seizure control), as well as within alternative definitions. These alternative definitions of efficacy included efficacy defined by positive changes in seizure duration and/or severity and efficacy defined by non-seizure symptom improvement. A retrospective chart review of demographic, initial visit, diet initiation, and 3-month visit data was conducted for patients ≤18 years who underwent diet initiation at the Dietary Therapies for Epilepsy Clinic at Children's National Medical Center between the years of 2015-2018. Sixteen patients (62%) had a percentage of seizure reduction from baseline to 3-month post diet. Of those patients, 10 (63%) saw a 50% or greater reduction in their seizures. Changes in seizure duration or severity could not be adequately assessed due to missing data. Of the 26 patients with a 3-month visit, 14 (54%) reported non-seizure symptom improvements. There were no diet or patient characteristic predictors of diet efficacy when efficacy was defined by seizure control, nor when the definition was altered to represent patients with non-seizure symptom improvement. Limitations of the study such as the small sample size and missing data resulted in a lack of available analyses for potential variables of interest, as well as the inability to perform rigorous data analysis. Standardized patient forms among clinics could be a useful tool to promote improved data collection and increase study sample sizes in the future. Improvements in data collection of both seizure and non-seizure symptoms would allow for enhanced investigation into the benefits and potential drawbacks of the KD beyond seizure control. Additionally, future research should focus on mechanism of action(s) for the KD, as this will help not only to further inform its potential use in epilepsy, as well as in other neurological disorders, but also aid in the creation of novel dietary therapies.