Recurrent unprovoked seizures caused by aberrant brain electrical activity are the hallmark of epilepsy, a chronic neurological condition [1]. All age groups are impacted, but children are especially vulnerable because of the effects of seizures on neurological development, cognition, education, and quality of life. Numerous issues, including as frequent hospital stays, long-term pharmaceutical use, developmental delays, behavioral issues, and psychological difficulties, are linked to pediatric epilepsy [2].

Achieving sufficient seizure control with few side effects from antiseizure drugs is essential for the successful management of epilepsy. A significant percentage of children still have recurrent seizures even after receiving the proper pharmaceutical treatments, even if many of them respond effectively to it. Treatment response is influenced by a number of variables, such as the kind of epilepsy, the age at which seizures begin, structural abnormalities, drug adherence, and concomitant illnesses. As a potentially controllable factor influencing neurological outcomes, dietary status has recently drawn attention [3].

The development of the brain, the manufacture of neurotransmitters, synaptic plasticity, and the preservation of neuronal function all depend heavily on nutrition. Protein, vitamin, mineral, and micronutrient deficiencies might affect brain function and perhaps change the vulnerability to seizures [4-5]. Numerous factors, such as feeding difficulties brought on by neurological impairment, decreased appetite linked to antiseizure drugs, dietary limitations, and higher energy requirements, can contribute to malnutrition in children with epilepsy.

Antiseizure drugs may also have metabolic effects that affect nutritional status. Changes in vitamin metabolism, bone health, weight fluctuations, and hunger disorders have all been linked to long-term use of several drugs. On the other hand, inadequate diet may have an impact on immunological response, drug metabolism, and physiological reserve, which may lessen the efficacy of epilepsy treatment [6].

Undernutrition is more common in children with epilepsy than in pediatric populations in good health, according to earlier research. Nutritional deficiencies seem to be more common in children with developmental delays, uncontrolled seizures, and recurrent seizure episodes. The ability of nutritional status to predict seizure outcomes and response to antiepileptic medication, however, is not well-established [7].

Comprehensive therapy of epilepsy may be possible if dietary problems are detected early. Simple anthropometric measurements can be used for nutritional assessment, making it possible even in healthcare settings with low resources. Combining routine epilepsy care with dietary evaluation may improve quality of life and therapeutic effects.

The goal of the current prospective follow-up study was to evaluate the connection between children with epilepsy's nutritional status and seizure management. Over the course of a six-month follow-up period, the study assesses whether baseline nutritional status can predict treatment response and seizure outcomes [8].

Aim

1. To evaluate nutritional status as a predictor of treatment response and seizure control in children with epilepsy during a prospective follow-up period.

Objectives

1. To assess the nutritional status of children with epilepsy using anthropometric parameters.
2. To evaluate the association between nutritional status and seizure control after initiation or continuation of antiepileptic treatment.
3. To compare treatment response between nutritionally adequate and malnourished children with epilepsy.

To identify nutritional and clinical factors associated with poor seizure control during follow-up

Study Design: Prospective Study.

A prospective observational follow-up study was conducted in the Department of Pediatrics/Pediatric Neurology at a tertiary care hospital. The study was designed to evaluate the association between nutritional status and treatment response among children diagnosed with epilepsy. Children fulfilling the eligibility criteria were enrolled and prospectively followed for a period of six months to assess seizure control and clinical outcomes.

The study included 100 children diagnosed with epilepsy who attended the pediatric outpatient department during the study period. A total of 100 pediatric patients with epilepsy were included in the study based on feasibility and availability of eligible participants during the study period. The study duration included patient recruitment and a six-month prospective follow-up period.

Inclusion Criteria

Children fulfilling the following criteria were included:

1. Children aged between 2–15 years diagnosed with epilepsy according to the clinical criteria of recurrent unprovoked seizures.
2. Children receiving antiepileptic medication therapy or newly initiated on antiepileptic treatment.
3. Children with documented seizure frequency at baseline and available follow-up records.
4. Patients whose parents or guardians provided written informed consent for participation.

Exclusion Criteria

1. Children were excluded if they had:
2. Acute symptomatic seizures due to fever, metabolic abnormalities, or acute infections.
3. Children with major congenital anomalies affecting nutritional status.
4. Severe systemic illness such as chronic kidney disease, chronic liver disease, or malignancy.
5. Children receiving ketogenic diet therapy for epilepsy.
6. Patients lost to follow-up before completion of the six-month assessment period.

Epilepsy classification was performed according to clinical history, electroencephalography findings, and available neuroimaging reports.

Assessment of Nutritional Status

Nutritional status was assessed at enrollment and during follow-up using standard anthropometric measurements.

Weight Measurement

Body weight was measured using a calibrated digital weighing scale. Children were weighed with minimal clothing and measurements were recorded in kilograms.

Height Measurement

Height was measured using a standardized stadiometer with the child standing upright according to recommended anthropometric techniques.

Body Mass Index (BMI)

• BMI was calculated using the formula:
• BMI = Weight (kg) / Height² (m²)
• BMI-for-age Z scores were calculated according to age and sex-specific reference standards.

Follow-Up Assessment

• Patients were reviewed at regular intervals during the follow-up period.
• At each visit, the following parameters were assessed:
• Seizure frequency
• Medication compliance
• Adverse effects of antiepileptic drugs
• Change in nutritional status
• Requirement for treatment modification
• Parents were advised to maintain seizure diaries to accurately record seizure episodes.

Statistical Analysis

Data were entered into a database and analyzed using appropriate statistical software. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages.

The following statistical tests were applied

• Chi-square test was used to analyze associations between categorical variables such as nutritional status and seizure control.
• Independent t-test was used for comparison of continuous variables between groups.
• Pearson correlation analysis was performed to assess relationships between nutritional parameters and seizure frequency reduction.
• Multivariate logistic regression analysis was performed to identify independent predictors of poor seizure control.

A p-value of <0.05 was considered statistically significant.

Table 1: Baseline Demographic and Clinical Characteristics of Children with Epilepsy (n=100)

Among the 100 children included in the study, 56 (56%) were males and 44 (44%) were females. The mean age of the study population was 8.2 ± 3.6 years. The majority of children belonged to the age group of 6–10 years. Poor nutritional status was identified in 38 children (38%), while 62 children (62%) had adequate nutritional status. Generalized epilepsy was the most common epilepsy type observed in the study population. The mean baseline seizure frequency was higher among children with poor nutritional status compared with children having adequate nutrition.

Table 2: Association between Nutritional Status and Seizure Control at 6 Months Follow-Up

At six months follow-up, children with adequate nutritional status demonstrated significantly better seizure control compared with children with poor nutritional status.

Among children with adequate nutritional status, 48 (77.4%) achieved good seizure control, whereas only 20 (52.6%) children with poor nutritional status achieved similar control.

The difference between groups was statistically significant (p = 0.014).

Table 3: Treatment Response According to Nutritional Status

Treatment response was assessed by calculating reduction in seizure frequency from baseline.

Children with adequate nutritional status showed a greater reduction in seizure frequency compared with malnourished children. A ≥50% reduction in seizure frequency was observed in 78% of adequately nourished children compared with 52.6% of children with poor nutritional status.

The difference was statistically significant (p = 0.011).

Table 4: Logistic Regression Analysis for Predictors of Poor Seizure Control

Multivariate logistic regression analysis was performed to identify factors independently associated with poor seizure control after six months.

Poor nutritional status, frequent baseline seizures, and polytherapy were found to be significant predictors of poor seizure outcomes.

Children with poor nutritional status had approximately 2.8 times higher odds of poor seizure control compared with children with adequate nutritional status.

Children with epilepsy suffer from a serious neurological condition that impacts their entire quality of life, cognitive development, physical growth, and psychosocial functioning. Treatment outcomes are influenced by a number of other factors, even though seizure control is mostly dependent on the proper selection and adherence to antiseizure drugs. In the current prospective follow-up study, 100 children with epilepsy had their nutritional condition assessed as a predictor of treatment response and seizure control [9].

In comparison to children with poor nutritional status, the current study showed that children with appropriate nutritional status had much improved seizure management. At the six-month follow-up, 52.6% of children with poor nutritional status and 77.4% of children with appropriate nutrition had satisfactory seizure control (p=0.014). According to this research, dietary status may have an impact on how well epilepsy is managed [10].

Children with acceptable nutritional status showed a considerably better response to treatment in the current trial. Compared to 52.6% of children with poor nutrition, 77.4% of children with appropriate nutrition showed a ≥50% decrease in seizure frequency (p=0.011). These results suggest that dietary evaluation should be regarded as a crucial part of all-encompassing epilepsy care [11].

According to earlier research, children undergoing long-term antiseizure treatment may be more susceptible to dietary problems. Certain drugs may have an impact on bone health, vitamin metabolism, hunger, and weight gain. Due to their larger pharmaceutical burden and more severe epilepsy, children taking numerous antiseizure medications may be more vulnerable to nutritional problems [12]. Additionally, polytherapy was found to be an independent predictor of poor seizure control in this trial.

Poor nutritional status was linked to higher likelihood of insufficient seizure control, according to the current study. Children with inadequate nutrition were 2.84 times more likely to have poor seizure control than children with appropriate nutrition, according to multivariate logistic regression (p=0.019). The significance of early nutritional evaluation and intervention in children with epilepsy is highlighted by this study [13].

While correcting dietary deficiencies may improve treatment responsiveness, overall health, and long-term neurological results, improving nutritional status alone may not be sufficient to substitute standard antiepileptic medication. Future research on particular micronutrient deficiencies and broader multicentric groups may shed further light on the connection between diet and epilepsy control [14].

The present study demonstrates that nutritional status is an important determinant of treatment response and seizure control in children with epilepsy. Children with adequate nutritional status showed significantly better seizure outcomes and higher treatment response rates compared with malnourished children.

Poor nutritional status was independently associated with increased risk of inadequate seizure control. Routine nutritional assessment should therefore be incorporated into the comprehensive management of pediatric epilepsy. Early identification and correction of nutritional deficiencies may improve therapeutic outcomes, support neurological development, and enhance quality of life among children with epilepsy.

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