Cognitive and behavioral impact of the ketogenic diet in children and adolescents with refractory epilepsy: A randomized controlled trial

- Patients using the ketogenic diet are reported as more active and productive.
- Less anxiety and mood problems are reported in children using the ketogenic diet.
- Improvement of activation in cognitive functioning during the ketogenic diet is seen.
- An activated mood and cognitive activation are observed during the ketogenic diet.
- The ketogenic diet has no negative impact on behavior and cognition in childhood.

PurposeThe ketogenic diet (KD) is increasingly used for the treatment of refractory epilepsy in childhood because of the beneficial effect on seizure reduction. The aim of the current study was to objectively assess cognition and aspects of behavior during the first 4 months of a randomized controlled study in children and adolescents.MethodsParticipants from a tertiary epilepsy center were randomized to a KD group (intervention) or a care-as-usual (CAU) group (control). Follow-up assessments on cognition and behavior were performed approximately 4 months after initiation of the KD with a combination of parent report questionnaires and individually administered psychological tests for the children.ResultsA total of 50 patients were enrolled in this study, 28 patients from the KD group and 22 patients from the CAU group. The KD group showed lower levels of anxious and mood-disturbed behavior and was rated as more productive. Cognitive test results showed an improvement of activation in the KD group.ConclusionsThis study showed a positive impact of the KD on behavioral and cognitive functioning in children and adolescents with refractory epilepsy. More specifically, an activated mood and cognitive activation were observed in patients treated with the KD.