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Effects of ketogenic diet on development and behavior: preliminary report of a prospective study
M B Pulsifer1, J M Gordon, J Brandt
1Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-7218, USA. pulsifer@jhmi.edu
Insights
The ketogenic diet significantly improved seizure control, cognition, and behavior in children with intractable epilepsy. Most children remained on the diet after one year, showing its long-term benefits.
Area of Science:
- Neurology
- Pediatrics
- Nutritional Science
Background:
- The ketogenic diet is a well-established therapy for drug-resistant epilepsy in children.
- Its effects on broader developmental and behavioral outcomes require further investigation.
Purpose of the Study:
- To prospectively evaluate the impact of the ketogenic diet on development, behavior, and parental stress in children with intractable seizures.
- To assess diet adherence and identify factors influencing its discontinuation.
Main Methods:
- A prospective study involving 65 children (18 months to 14 years 6 months) with intractable seizures.
- Children were assessed before and 1 year after initiating the ketogenic diet, measuring seizure frequency, developmental quotient, behavior, and parental stress.
Main Results:
- 52% of children remained on the diet at 1-year follow-up.
- Mean daily seizure frequency decreased from 25 to under 2.
- Statistically significant improvements were observed in developmental quotient, attention, and social functioning.
- Parental stress levels remained largely unchanged.
Conclusions:
- The ketogenic diet demonstrates significant efficacy in reducing seizure frequency in children.
- The diet positively impacts cognitive development and behavior, supporting its use beyond seizure management.
- Diet adherence is primarily influenced by seizure control, with no baseline factors predicting adherence.
Abstract:
The ketogenic diet is increasingly used for the management of difficult-to-control seizures in children. Here, we describe the first prospective study of the effects of the diet on development, behavior, and parenting stress. Participants were 65 children (36 males, 29 females) with intractable seizures, ages 18 months to 14 years 6 months, enrolled in a prospective study at the Johns Hopkins Hospital, Baltimore, MD, USA, to study the diet's efficacy. Children were assessed before diet initiation and at 1-year follow-up. At follow-up, 52% (34 of 65) children remained on the diet. Mean seizure frequency decreased from 25 per day before diet initiation to less than two per day 1 year later. At follow-up, mean developmental quotient showed statistically significant improvement (p<0.05), with significant behavioral improvements in attention and social functioning. Parental stress was essentially unchanged. No baseline factor examined predicted diet adherence, and the primary reason for diet discontinuation was insufficient seizure control. These preliminary results support prior anecdotal reports of the beneficial effects of the diet on cognition and behavior.
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