• Impact of the Ketogenic Diet on Seizure Control and Cognitive Function in Children with Neurometabolic Disorders
  • Fatemeh Jooya,1 Mohammad Moein Mokhtarezadeh,2,* Sara Sayahpoor,3
    1. MSc student of pediatric nursing, Department of nursing, School of nursing and midwifery, Aliabad Katul Branch, Islamic Azad University, Golestan, Iran.
    2. Medical Student, Student Research Committee, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
    3. MSc student of pediatric nursing, Department of nursing, School of nursing and midwifery, Aliabad Katul Branch, Islamic Azad University, Golestan, Iran.


  • Introduction: Neurometabolic disorders in children, such as glucose transporter type 1 deficiency and mitochondrial diseases, are often associated with refractory seizures and cognitive impairments. Pharmacological treatments may offer limited seizure control, necessitating alternative therapeutic approaches. The ketogenic diet (KD), a high fat, low carbohydrate regimen, has been proposed to improve seizure control by shifting cerebral energy metabolism and potentially enhancing cognitive function. This systematic review aimed to evaluate the impact of the ketogenic diet on seizure control and cognitive outcomes in pediatric patients with neurometabolic disorders.
  • Methods: Following PRISMA 2020 guidelines, a comprehensive literature search was performed in PubMed, Scopus, Web of Science, and the Cochrane Library for studies published between January 2010 and April 2025. Search terms included “ketogenic diet,” “neurometabolic disorders,” “children,” “seizures,” and “cognition.” Inclusion criteria encompassed interventional or observational studies involving children (<18 years) diagnosed with neurometabolic disorders, receiving KD for ≥3 months, and reporting seizure frequency and/or cognitive performance with validated measures. Studies lacking outcome data or involving non pediatric populations were excluded. Methodological quality was appraised using the Joanna Briggs Institute critical appraisal checklists. Data synthesis was primarily narrative, with pooled effect sizes calculated when homogeneity permitted.
  • Results: Fourteen studies involving 462 children (ages 6 months–17 years) diagnosed with various neurometabolic disorders—including Glut1 deficiency (n = 198), mitochondrial diseases (n = 156), pyruvate dehydrogenase deficiency (n = 54), and others—met the inclusion criteria. Ketogenic diet durations ranged from 3 months to 3 years. Pooled analysis demonstrated ≥50% seizure reduction in 72% (95% CI: 67–77%) of participants, with complete seizure freedom in 28% (95% CI: 23–33%). Mean time to onset of seizure reduction was 4.2 weeks (range: 2–8 weeks). Cognitive outcomes, assessed in 9 studies using standardized neuropsychological batteries, showed a moderate effect size improvement in composite scores (SMD = 0.43; 95% CI: 0.28–0.58), most consistently in attention (+0.48) and language (+0.39) subdomains. Adverse effects were reported in 38% of cases, most commonly gastrointestinal symptoms (24%), dyslipidemia (9%), and nephrolithiasis (5%); >90% were mild/moderate and responsive to dietary adjustment or supportive care. Attrition rates due to intolerance or non adherence ranged from 5% to 12%.
  • Conclusion: The ketogenic diet appears effective in achieving substantial seizure reduction and moderate cognitive improvements in children with neurometabolic disorders. Its integration into multidisciplinary pediatric care may provide benefits where pharmacotherapy alone is insufficient. Long term randomized controlled trials are warranted to establish optimal dietary protocols and evaluate sustained cognitive outcomes.
  • Keywords: Ketogenic Diet; Neurometabolic Disorders; Seizure Control; Cognitive Function; Pediatric.