MF. Nassar, OF. El-Rashidy, MO. Shata, MA. ElHagaar and RI. Abdelmageed (2026). Ketogenic diet for pediatric drug-resistant epilepsy: sleep, children's psychosocial functioning, and maternal mental health. Pediatric research. https://doi.org/10.1038/s41390-026-05330-8

PubMed 42521800

[Abstract]
BACKGROUND: Despite increasing attention to ketogenic dietary therapy (KDT) for drug-resistant epilepsy (DRE) in children, research examining its impact on non-seizure outcomes in children and their mothers remains limited. This study examined effects of KDT on sleep quality, children's psychosocial functioning, and maternal mental health.

METHODS: This prospective study followed 40 children with DRE and their mothers from baseline to 4 and 12 weeks after KDT initiation. Children's sleep and psychosocial functioning were assessed using the Children's Sleep Habits Questionnaire and the Strengths and Difficulties Questionnaire. Maternal sleep and mental health were evaluated using the Pittsburgh Sleep Quality Index and the Depression Anxiety and Stress Scale.

RESULTS: Significant improvements in children's sleep and psychosocial functioning, as well as maternal sleep and mental health symptoms, were observed at 4 weeks, with the greatest improvements at 12 weeks. Regression analyses showed changes in seizure severity were associated with improvements in children's sleep and psychosocial functioning. Improved children's sleep was associated with better psychosocial outcomes. Maternal sleep quality and stress demonstrated a reciprocal relationship.

CONCLUSIONS: A 12-week KDT was associated with improvements in children's sleep quality and psychosocial functioning, as well as maternal sleep quality and mental health, suggesting benefits beyond seizure control.

IMPACT STATEMENT: KD has recently gained attention in pediatric drug resistant epilepsy (DRE) management, and further potential assets for patients and families should be emphasized. KD is a tolerable, safe, and effective line of therapy in pediatric DRE without significant negative impacts on the patients. The positive effect of KD on sleep and psychological function of pediatric patients, as well as mothers' mental health, are promising findings, and wider scale studies and longer KD usage can prove additional achievements in treated patients.