Association between nutritional status of pediatric patients with refractory epilepsy and clinical response to the ketogenic diet

Abstract

Background: The ketogenic diet (KD) is a high-fat, low-carbohydrate diet, prescribed for pediatric patients with refractory epilepsy. Although effective, the response to KD depends on factors that must be identified. Objectives: to evaluate the impact of nutritional status of pediatric patients on the KD clinical response. Methods: This is a retrospective longitudinal study based on the follow-up of patients with refractory epilepsy (ICr-FMUSP) in treatment with KD after 3 (T1) and 6 months (T2). At baseline, patients were split into Eutrophic group (EG; BMI ≤25 kg/m2) and Non-Eutrophic group (NEG; BMI>25 kg/m2). The clinical efficacy of KD was assessed by the percentage of epileptic seizures reduction and classification in responders (reduction ≥ 50%) versus non-responders. Results: KD resulted in seizures reduction at T1 (-66.7%) and T2 (- 74.2%). Both groups showed reduction at T1 (GE = -70%; NEG = -67%; p = 0.704) and T2 (GE = -83%; NEG = -55%; p = 0.094). At T2, EG presented 79.2% of responders and NEG 56.2% (p = 0.166). Eight patients (30.8%) of GE achieved 100% seizure reduction at T1 and maintained it, while six patients (28.6%) of GNE who achieved 100% seizure reduction at T1 and only 3 (18.8%) kept it at T2. Conclusions: KD promotes seizure reduction. As for clinical efficacy, EG presented a 29% higher percentage of responders than NEG. All GE patients who had total seizure control at T1 maintained it at the end of the study. There is need of further studies with larger samples.