Abstracts

RATIONALE: The ketogenic diet is currently chosen as a treatment only for children with drug-resistant epilepsy. Many children considered for the diet exhibit substantial developmental delays. There are many anecdotal reports of improved behavior and increased alertness in children on the ketogenic diet. No systematic investigation of improvements exists in the literature. This pilot study examines changes in a broad spectrum of developmental domains in children on the diet.
METHODS: The Battelle Developmental Inventory (BDI) was employed because it: uses structured tests, parent interviews and observation of the child; quantitative data are scored in personal-social, adaptive, fine and gross motor, receptive and expressive communication and cognitive domains and it has provisions for physical disabilities. The BDI was performed 4 times: in the week prior to fasting (baseline) and after 1, 4 and 6 months on the diet.
Baseline data were obtained on 14 subjects, of these, 1, 4 and 6 month data were collected on 9,7 and 6 subjects respectively. Children had absence, myoclonic, tonic clonic and/or atonic seizures. Medications were not altered while on the study. At baseline, mean age was 41 months (range 21 to 182 months).
For each subject, predicted development was based on the chronological age of the child at baseline and their developmental level on each BDI domain. T-tests were performed to determine if changes in developmental age exceeded those predicted by prior development.
RESULTS: At baseline, the mean developmental age of subjects was 14 months (range 6 to 50 months). After one month on the diet, significant advances compared to expected development were found across all BDI domains except gross motor. After 4 months, the total BDI score was still significantly improved. At 6 months, despite smaller subject number, the fine motor and cognitive domains still showed significant advancements. At 4 and 6 months, there was also a trend for receptive communication to be better than expected.
CONCLUSIONS: All subjects exhibited developmental delays prior to the diet. Significant gains were seen after one month on the diet which surpassed those expected from the individual[ssquote]s previous development. All BDI domains except gross motor improved. There were also advances in receptive communication and fine motor skills at 4 and 6 months despite smaller numbers of subjects.
This is the first systematic investigation of neurocognitive improvements in children on the ketogenic diet. Sustained improvements in receptive language are of interest and may be responsible for anecdotal reports of improved [dsquote]alertness[dsquote]. This work highlights the importance of considering not only seizure reduction, but also potential neurodevelopmental advances when informing parents and making treatment decisions.
Support: Bloorview Epilepsy Research Program, Bloorview-MacMillan Centre and the University of Toronto.