The impact of ketogenic diet on the frequency of psychogenic non-epileptic seizures (PNES): A feasibility randomized pilot study.

Abstract

The potential of dietary interventions, particularly the use of the ketogenic diet in patients with Psychogenic Non-Epileptic Seizures (PNES), remains underexplored. This study aimed to assess the feasibility of a 6-week ketogenic diet (Modified Atkins Diet, MAD) intervention in adult patients with PNES and to compare its effects on PNES frequency and other variables against a control healthy diet (CD). A feasibility pilot randomized controlled trial was conducted at a tertiary neurology hospital, enrolling outpatients diagnosed with PNES and assigning them to either MAD or CD. Baseline and follow-up assessments (at 2, 4, and 6 weeks) included evaluation of mental health, PNES frequency, and metabolic measures. Descriptive and inferential methods, including repeated measures ANOVA, were used for statistical analysis. Seventeen patients (mean age 28.23 ± 7.1) were randomly allocated to receive either MAD (n = 12) or CD (n = 5). The entire sample exhibited a significant decrease in monthly PNES frequency (p = 0.01, Hedges ES = 0.618) without differences between groups. The MAD group showed significant improvement in PNES frequency, depression, and anxiety at week six. Results demonstrate that the implementation of MAD is feasible in patients with PNES and suggest that it may reduce seizure frequency and symptoms of depression and anxiety. These findings warrant further investigation in larger, powered studies to demonstrate efficacy. PLAIN LANGUAGE SUMMARY: This study explored the potential benefits of the Modified Atkins Diet (MAD) in reducing the frequency of psychogenic non-epileptic seizures (PNES). The results showed that the diet is safe, well-tolerated, and may decrease the occurrence of PNES, as well as symptoms of depression and anxiety. These findings suggest that dietary modifications could be a helpful complement to PNES treatment, though larger studies are necessary to confirm these outcomes.