Ketogenic Diet Combined with Medication: The Optimal Approach for a 2-Year-Old Child with Epileptic Encephalopathy

In the case of a 2-year-old child diagnosed with epileptic encephalopathy shortly after birth, effective treatment required more than just medication. Despite ongoing pharmacological therapy, the child continued to experience frequent seizures. Upon further investigation, it was discovered that poor dietary control played a significant role in the recurrence of symptoms. To prevent long-term developmental delays and cognitive or motor impairments, a combination of prescribed antiepileptic drugs and a structured ketogenic diet was introduced. Following this integrated treatment plan, the frequency of seizures significantly decreased, and the child's condition became more stable.

Case Overview

Patient: Female, 2 years oldDiagnosis: Epileptic EncephalopathyHospital: Shandong Third Provincial HospitalVisit Date: November 2017Treatment: Combination of antiepileptic medications (Topiramate, Sodium Valproate, Clonazepam) and ketogenic dietTreatment Duration: Outpatient visits with one-month follow-up and subsequent checkups every three monthsOutcome: Stabilized condition with reduced seizure frequency and improved overall development

Initial Assessment

This patient presented with a complex neurological condition. From birth, she experienced frequent epileptic seizures and showed signs of developmental delay, including stunted growth and delayed speech. Her parents reported that she had been suffering from spasms since infancy. After undergoing brain MRI, EEG, and genetic testing, she was diagnosed with epileptic encephalopathy linked to a genetic mutation. Recently, under the care of her grandmother, the child began experiencing increased muscle spasms and seizures despite being on medication. Her response to the prescribed drugs had diminished, prompting a return visit to the clinic. Upon physical examination, motor developmental delays were confirmed. Further tests, including EEG, MRI, and blood drug level assessments, were recommended for a comprehensive evaluation.

Therapeutic Intervention

Test results confirmed that the child's blood drug levels were within the therapeutic range, and no new abnormalities were found on MRI. However, EEG revealed spike-and-wave discharges in the frontal and central regions of the brain. The parents were questioned further about the child's lifestyle and eating habits. It was revealed that the child had unrestricted access to snacks and consumed a high-carbohydrate diet. Considering the lack of response to medication alone and the absence of contraindications for dietary therapy, a ketogenic diet was introduced as a complementary treatment.

Implementing the Ketogenic Diet

The ketogenic diet is a well-established nutritional strategy in managing drug-resistant epilepsy. It involves a high-fat, moderate-protein, and low-carbohydrate food plan, typically following a 4:1 or 3:1 fat-to-protein-and-carbohydrate ratio. Parents were advised to carefully monitor the child's meals and document any seizure activity. In conjunction with the continued use of Topiramate, Sodium Valproate, and Clonazepam, this dietary intervention was implemented. One month later, the child showed noticeable improvement with fewer spasms and no adverse effects reported.

Positive Outcomes

After incorporating the ketogenic diet, the child's seizure frequency declined significantly. Follow-up EEG results also showed a reduction in epileptic discharges. A one-month phone follow-up confirmed that the child's condition remained stable with no relapses. The parents were advised to continue the treatment plan and schedule follow-up appointments every three months at the neurology clinic to monitor progress and ensure ongoing seizure control.

Key Recommendations for Caregivers

With the child's condition improving, it was crucial to maintain consistency in both medication and dietary habits. Parents were encouraged to establish a structured eating schedule, avoid processed snacks and high-carb treats, and promote healthy lifestyle habits. Physical overexertion and sleep deprivation were identified as potential seizure triggers, so moderate outdoor activities and emotional well-being were emphasized. In the event of infections such as colds or fevers, prompt medical attention was advised to prevent complications.

Clinical Insights and Patient Guidance

Epileptic encephalopathy is often associated with genetic mutations, highlighting the importance of prenatal genetic screening. Once diagnosed, patients should seek specialized care for accurate diagnosis and standardized treatment. Regular follow-ups are essential to monitor treatment response and developmental progress. As seen in this case, combining medication with a ketogenic diet can lead to significant improvements. Establishing a strong doctor-patient relationship and maintaining regular clinic visits can help families stay informed and confident in managing the child's long-term health.