Speckle-tracking echocardiographic assessment of cardiac function in children with refractory epilepsy receiving a ketogenic diet

BACKGROUND Refractory epilepsy (RE) in childhood remains a major therapeutic challenge. ketogenic diet (KD) is widely used as an effective non-pharmacological therapy; however, KD-related metabolic changes may potentially affect myocardial structure and function. Therefore, assessment of cardiac performance in children receiving KD therapy is clinically relevant. This study aimed to assess cardiac function in children presenting with RE and receiving KD therapy using two-dimensional speckle tracking echocardiography (2D-STE) for early detection of myocardial dysfunction. METHODS This comparative observational study with cross-sectional cardiac evaluation included 105 children aged 2–10 years, divided into three equal groups: 35 children with RE receiving KD in addition to antiseizure medications (ASM), 35 children with RE receiving ASM only, and 35 healthy controls. All enrolled participants were subjected to comprehensive cardiac evaluation using electrocardiography (ECG), conventional echocardiography, TDI, and 2D-STE. Metabolic parameters, including lipid profile, blood glucose, and urinary ketones, were assessed. Seizure frequency was recorded before and after KD initiation. RESULTS evaluation of Left ventricular systolic and diastolic functions by conventional, TDI, and ECG were comparable among the three groups and remained within normal pediatric reference ranges. Global longitudinal strain (GLS) was statistically lower in KD group; however, values remained within normal limits, indicating no clinically relevant myocardial dysfunction. KD therapy resulted in significant decrease in seizure frequency, while changes in lipid profile remained within accepted pediatric reference ranges. Conclusion KD therapy in children with RE was not associated with adverse effects on cardiac structure, function, or electrical activity and was effective in achieving significant seizure reduction. These findings support the cardiac safety of KD when appropriately monitored.