Classroom
Tuesday, August 30, 2016

As school is now back in session for most children, the timing of a recent article from the Netherlands in Epilepsy and Behavior seems most opportune! This study evaluated whether the ketogenic diet improved aspects of behavior, learning, and memory independent of seizures and medication.

This question is a very tough one to answer. Parents often will say that their child with epilepsy is doing better in school and is “calmer” after months of using the ketogenic diet, but is that due to 1) less sedating medications, 2) fewer seizures, or 3) improved EEG?  As you can imagine, trying to keep those variables the same when starting the diet can be a challenge in a clinical trial.

But it’s important… one study from our center in 2006 found that 90% of families had cognitive improvement as a goal for starting the ketogenic diet. And… if their child did have improvement in learning, it was very highly linked with how long the family stayed on the diet (even more linked than seizure reduction!).

Only limited studies, most notably a study by Pulsifer et al. from 15 years ago, have tried to tackle this question, and they found signs of improvement with ketogenic diet use.

New Study on Ketogenic Diet for Childhood Epilepsy

This study from Ijff and colleagues is a big step in the right direction for proving that the diet seems to help. As a side analysis from a large, randomized, controlled study of the ketogenic diet for childhood epilepsy, this group also looked not just at seizures, but also various detailed scales of mood, behavior, vocabulary, emotions, and memory. They tested 28 children on the ketogenic diet (and 22 who continued medications without changes) at baseline and then again at 4 months.

What did they find?

  • Children on the ketogenic diet had better scores than controls in “vigor” (energy), “productivity,” and “anxious and mood-disturbed behavior”
  • Fatigue, attention-deficit, autistic behavior, and depression weren’t any different.
  • In learning, there was an improvement in word comprehension on the Peabody Picture Test, but no other obvious differences.
  • Only “vigor” was linked to seizure reduction… in other words, all of the other scores that improved were independent of seizures!
Activated Mood and Cognitive Activation

(Figure 1 from the article: Summary of the Ketogenic Diet effects on mood and cognition. Courtesy S. Schachter and Epilepsy and Behavior)

This is good news for parents and suggests the ketogenic diet may have some limited, but positive effects on some aspects of behavior (and perhaps on cognition). Most ketogenic diet centers never promise this to families, but perhaps there is some evidence now that we can?

Stay tuned for more research to come in this area!

Reminder

The 5th Global Symposium on Ketogenic Therapies will be held September 20-24, 2016, in Banff, Alberta, Canada. This event has SOLD OUT! This message is from the organizers:

"We are deeply sorry that we cannot accommodate anymore attendees in person at the conference; however, we still want you to experience the cutting edge programming we have lined up for this year. We will be offering the event online via live streaming. The even better news is that you can still get CME credit for participating in the live-stream. There will also be an interactive chat option where you can submit questions in real time that will be fielded to the ballroom in Banff for our speakers to answer. We will be announcing the live-stream registration on www.ketoconnect.org."

References

Ijff DM, Postulart D, Lambrechts DAJE, Majoie MHJM, de Kinderen RJA, Hendriksen JGM, Evers SMAA, Aldenkamp AP. Cognitive and behavioral impact of the ketogenic diet in children and adolescents with refractory epilepsy: A randomized controlled trial. Epilepsy Behav 2016;60:153-157.

Farasat S, Kossoff EH, Pillas DJ, Rubenstein JE, Vining EP, Freeman JM. The importance of parental expectations of cognitive improvement for their children with epilepsy prior to starting the ketogenic diet. Epilepsy Behav 2006;8:406-410.

Pulsifer MB, Gordon JM, Brandt J, Vining EP, Freeman JM. Effects of ketogenic diet on development and behavior: preliminary report of a prospective study. Dev Med Child Neurol 2001;43:301-306.

Authored by: Eric Kossoff MD | Ketogenic Diet Editor on 8/2016