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Article

Graph Theory-Based Electroencephalographic Connectivity and Its Association with Ketogenic Diet Effectiveness in Epileptic Children

1
Division of Pediatric Neurology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
2
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital and School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei 11217, Taiwan
3
Division of Pediatric Cardiology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
4
Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, 19F, No.172-1, Sec. 2, Keelung Rd., Da’an Dist., Taipei City 10675, Taiwan
*
Author to whom correspondence should be addressed.
Academic Editors: Anna Tagliabue and Cinzia Ferraris
Nutrients 2021, 13(7), 2186; https://doi.org/10.3390/nu13072186
Received: 26 April 2021 / Revised: 20 June 2021 / Accepted: 22 June 2021 / Published: 25 June 2021
(This article belongs to the Special Issue Ketogenic Dietary Therapies in Neurological Disorders)
Ketogenic diet therapies (KDTs) are widely used treatments for epilepsy, but the factors influencing their responsiveness remain unknown. This study aimed to explore the predictors or associated factors for KDTs effectiveness by evaluating the subtle changes in brain functional connectivity (FC) before and after KDTs. Segments of interictal sleep electroencephalography (EEG) were acquired before and after six months of KDTs. Analyses of FC were based on network-based statistics and graph theory, with a focus on different frequency bands. Seventeen responders and 14 non-responders were enrolled. After six months of KDTs, the responders exhibited a significant functional connectivity strength decrease compared with the non-responders; reductions in global efficiency, clustering coefficient, and nodal strength in the beta frequency band for a consecutive range of weighted proportional thresholds were observed in the responders. The alteration of betweenness centrality was significantly and positively correlated with seizure reduction rate in alpha, beta, and theta frequency bands in weighted adjacency matrices with densities of 90%. We conclude that KDTs tended to modify minor-to-moderate-intensity brain connections; the reduction of global connectivity and the increment of betweenness centrality after six months of KDTs were associated with better KD effectiveness. View Full-Text
Keywords: ketogenic diet therapy; drug-resistant epilepsy; interictal electroencephalography; graph theory; functional connectivity ketogenic diet therapy; drug-resistant epilepsy; interictal electroencephalography; graph theory; functional connectivity
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  • Externally hosted supplementary file 1
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    Description: Figure S1. Flowchart of patient enrollment. We enrolled 46 subjects initially. Ten of them dropped out before 3-month follow-up, and one before 6-month follow-up due to children’s factors, parents’ factors, poor efficacy, or death. Four subjects were excluded for incomplete EEG data. Thirty-one subjects were finally included in this study, of whom 17 were KDT responders and 14 were non-responders.
  • Externally hosted supplementary file 2
    Link: https://drive.google.com/drive/folders/1EtEE-esWg4EY9sf3_3sN3uETG6wb0WpU?usp=sharing
    Description: Table S1. Patients’ document. The clinical raw data of responders and non-responders were listed in this table. The six months seizure frequency means the average frequency during the first 6 months of ketogenic diet therapy. The six months seizure reduction rate (%) = (Baseline seizure frequency –six months seizure frequency) / Baseline seizure frequency x 100%. Responders were those who achieved a six months seizure reduction rate of 50% or more.
MDPI and ACS Style

Su, T.-Y.; Hung, P.-L.; Chen, C.; Lin, Y.-J.; Peng, S.-J. Graph Theory-Based Electroencephalographic Connectivity and Its Association with Ketogenic Diet Effectiveness in Epileptic Children. Nutrients 2021, 13, 2186. https://doi.org/10.3390/nu13072186

AMA Style

Su T-Y, Hung P-L, Chen C, Lin Y-J, Peng S-J. Graph Theory-Based Electroencephalographic Connectivity and Its Association with Ketogenic Diet Effectiveness in Epileptic Children. Nutrients. 2021; 13(7):2186. https://doi.org/10.3390/nu13072186

Chicago/Turabian Style

Su, Ting-Yu, Pi-Lien Hung, Chien Chen, Ying-Jui Lin, and Syu-Jyun Peng. 2021. "Graph Theory-Based Electroencephalographic Connectivity and Its Association with Ketogenic Diet Effectiveness in Epileptic Children" Nutrients 13, no. 7: 2186. https://doi.org/10.3390/nu13072186

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