Efficacy of the ketogenic diet in Chinese children with Dravet syndrome: A focus on neuropsychological development

Objectives: In this retrospective study, we evaluated the efficacy of the ketogenic diet (KD) treatment in Chinese children with Dravet syndrome (DS) as well as its effect on neuropsychological development.

Methods: Twenty-six children (14 male) living with DS and being treated with KD at our department between July 2014 and December 2017 were enrolled in the study. The efficacy of KD was measured by seizure frequency before and after the diet. Additionally, children's neuropsychological development, as evaluated by the Gesell developmental schedule, was compared between the KD and a non-KD group.

Results: After 3, 6, 12, 18, 24, and 30 months, 92.3%, 84.6%, 46.2%, 30.8%, 19.2%, and 19.2% remained on the KD, while 38.4%, 34.6%, 38.4%, 23.0%, 15.4%, and 15.4% showed >50% reduction in seizure. The development age (DA) subscores of 12 children, as measured by the Gesell developmental schedule, increased after commencement of KD. However, children's development quotient (DQ) subscores (age-adjusted) decreased after KD. In the non-KD group (40 participants), an increase of DA subscores and decrease of DQ subscores were also observed. Results found no difference in changes of DQ subscores over time between the two groups. The DQ subscores after the diet in the KD group (20 participants) did not differ significantly when compared to the DQ subscores at same age in the non-KD group (20 patients) (t-test).

Conclusions: The DA subscores of 12 children in KD group increased after KD; when compared with that of the non-KD group, no significant difference was observed in respect to the changes of DQ subscore over time. Effects on cognitive and other neuropsychological development outcomes of KD for children living with DS require further study.