Macronutrient Ratios: The Miraculous Impact of Fixing Dietary Puzzle in Treating Children with Epilepsy

Background: Epilepsy is a chronic neurological disorder. Drug-resistant epilepsy (DRE) occurs when seizures persist despite adequate trials of two or more antiseizure medications (ASMs), affecting 30% of epilepsy patients and posing significant health challenges. The ketogenic diet (KD), a high-fat, low-carbohydrate diet, has emerged as a promising nonpharmacological treatment for DRE. This diet induces ketosis, providing an alternative energy source for the brain and reducing seizure frequency. This study aimed to evaluate the effectiveness of an Indianized version of the KD in reducing seizure frequency among children with DRE. The study presents a novel approach by demonstrating that a KD, traditionally considered difficult for South Indian populations, can be successfully adapted using household familiar foods without depending on a specialized commercially available keto formula to treat DRE. The work underscores the importance of cultural customization in dietary interventions, showing its feasibility for long-term adherence, and highlights the diet’s potential as a complementary therapy in DRE. Methodology: An open-label intervention study was conducted at Sri Ramachandra Medical Centre, Chennai, with 20 pediatric patients aged 1 month to 5 years with DRE who were referred by the epileptologist for dietary intervention between June 2024 and September 2024. The study was carried out for a duration of 3 months using the nutrition care process model to provide individualized KDs based on nutritional assessments. Weekly teleconsultations and monthly outpatient visits monitored growth, side effects, and seizure frequency. Biochemical parameters were tracked monthly. Data analysis utilized mean, standard deviation, and paired t -tests, with statistical significance defined as P < 0.05. Results: Of the 20 eligible participants enrolled in the study at baseline, (12) 60% of participants had normal nutritional status, (four) 20% were at moderate risk of malnutrition, and (four) 20% were at severe risk. Postintervention, (19) 95% achieved normal nutritional status, with only (one) 5% at moderate risk. The P -value from McNemar’s test suggests a statistically significant ( P < 0.020) improvement in the nutritional status of participants after following the KD. Seizure frequency outcomes showed that (six) 30% of participants became seizure-free, (four) 20% had over 90% reduction, (five) 25% experienced a 50%–90% reduction, (three) 15% had less than a 50% reduction, and (two) 10% saw no reduction. The P -value from the Wilcoxon test indicates a significant reduction ( P < 0.031) in seizure frequency postintervention. Initial adverse effects, such as vomiting and lethargy, were reported by (eight) 40% of participants but diminished within a week. Biochemical assessments revealed normal blood glucose and lipid levels in (16) 80% of participants, with (four) 20% experiencing hypoglycemia. The number of ASMs was reduced in (four) 20% of participants while the remaining continued with the same ASMs dosage. Conclusion: This study underscores the potential of the KD as an effective intervention for patients with drug-resistant seizures. It is also essential to note that the KD can be achieved from within the framework of foods familiar and acceptable to the family, without the utilization of commercial supplements. The significant reduction in seizure frequency highlights the importance of early dietary intervention and the role of a medical nutrition therapist in controlling drug-resistant epilepsy.