Efficacy Of Modified Ketogenic Diet For Cognitive Impairment In Refractory Epileptic Co-morbidities

Objective:The purpose of this study was to investigate the efficacy of a modified ketogenic diet(KD)-medium-chain triglyceride diet(MCTD)added to treat patients with refractory epileptic co-morbid cognitive impairment.Methods:A prospective self-controlled study was used to collect 22 patients diagnosed with refractory epilepsy comorbid cognitive impairment in the outpatient and inpatient department of the Department of Neurology,First Hospital of Shanxi Medical University from November 2021 to October 2022,and the clinical data of the patients were recorded,and the seizure frequency,EEG,MOCA scale(≥16 years old)and Wechsler Intelligence Scale(6-15 years old),Hamilton Anxiety Scale(HAMD),before the start of MCTD treatment and 3 months after treatment,were compared.Changes in the Hamilton Depression Scale(HAMA)to assess its efficacy.The statistical software SPSS26.0 was used for statistical analysis,and the test level was P=0.05.Results:1)In 19 patients treated with MCTD,the effective rate of seizure control treatment was 84.21% and the ineffectiveness rate was 15.79%,and the efficacy was not related to seizure type,type of anti-seizure medication,age,or age of onset(P>0.05).2)In patients≥16 years old,the total score of Mo CA scale score was higher after ketogenic treatment than before ketogenic treatment,and the difference was statistically significant(P<0.05);in visuospatial and executive,attention,and delayed recall,the differences were greater after ketogenic treatment than before ketogenic treatment,and the differences were statistically significant(P<0.05),but there were no statistically significant differences before and after ketogenic treatment in naming,language,abstraction,and orientation(P>0.05);in patients aged 6-15 years,the Wechsler Intelligence Scale scores were higher after ketogenic treatment than before ketogenic treatment,and the differences were(P<0.05).3)In patients with anxiety and depression,HAMA and MAMD scores were lower after ketogenic treatment than before ketogenic treatment,and the difference was statistically significant(P<0.05).4)Among the three patients who withdrew from the study,one child withdrew from the study because of picky eating and refusal to eat MCT powder,one child and one adult withdrew from the study for financial reasons.Conclusion:MCTD can be used as a safe and effective add-on treatment for patients with refractory epilepsy co-morbid cognitive impairment.MCTD has few adverse reactions,mainly gastrointestinal discomfort,but most of them can be adapted and have high safety.