Clinical, Nutritional, and Therapeutic Determinants of Pediatric Drug-resistant Epilepsy Disease Progression – A Retrospective Study

Objectives: Drug-resistant epilepsy (DRE) in children under 5 years old is a severe condition with profound implications for neurodevelopment, growth, and quality of life. Despite appropriate treatment with antiseizure medications (ASMs), these children continue to experience seizures, disrupting developmental milestones. Identifying clinical, demographic, and nutritional factors influencing DRE progression is crucial for optimizing management and improving long-term outcomes. The aim of this study was to evaluate the clinical, demographic, and nutritional factors influencing the progression of DRE in children under 5 years and assess their impact on seizure outcomes and developmental delays. Material and Methods: This retrospective study was conducted at the Department of Neurology, Sri Ramachandra Hospital, Chennai, Tamil Nadu, India. Medical records of fifty children aged 0–5 years diagnosed with DRE between January 2020 and December 2024 were reviewed. Data collected included age, gender, seizure type, ASMs treatment, and nutritional status (weight-for-age z-scores). Nutritional status was categorized as normal, moderate malnutrition, or severe malnutrition. Statistical analysis involved chi-square tests for categorical variables and t -tests for continuous variables. Results: Fifty pediatric patients with DRE were included. The mean age at diagnosis was 3.1 ± 1.2 years, with a male-to-female ratio of 1.3:1. Seizure frequency varied, with 19 (38%) patients experiencing severe malnutrition. Focal seizures were most common, affecting 27 (54%) patients, followed by generalized seizures, impacting 15 (30%) patients. Despite polytherapy with ASMs, no patient achieved sustained seizure freedom. Biochemical abnormalities were observed in 21 (42%) of cases, and 32 (64%) of patients exhibited developmental delays. All participants in our study had undergone trials with at least two different ASMs at their upper tolerable doses, yet seizures could not be adequately controlled. Therefore, these patients were diagnosed as having DRE. Furthermore, the diagnosis of DRE serves as an indication to initiate dietary therapy, such as the ketogenic diet. According to established guidelines, dietary therapy should only be considered once there has been documented failure of appropriately selected and tolerated anti-seizure medications. In the present study, the participants had not received any form of dietary therapy; they were managed solely with standard pharmacological treatment. Upon analysis, they fulfilled the criteria for DRE, and therefore, dietary therapy should be recommended as the next line of management. Conclusion: This study emphasizes the role of early interventions targeting malnutrition and seizure frequency in improving outcomes. The failure of current pharmacological therapies highlights the need for alternative treatments, including dietary strategies and novel medications. The study’s findings advocate for a comprehensive, multidisciplinary approach to managing pediatric DRE. This work also aligns with the United Nations Sustainable Development Goal 3, which emphasizes healthy lives and promoting well-being for all regardless of age.