Effect of the modified Atkins diet in adults with drug-resistant epilepsy: A controlled study.

The objective of this study was to be a proof of concept of an analysis strategy to assess the effectiveness of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE). This retrospective cohort study included participants aged >16 years with at least two failed antiseizure medications (ASMs). The variables were self-reported and gathered from medical records or phone calls. Two groups are compared: MAD adjuvant to ASM (diet group) and ASM only (control). To make both groups comparable, diet and control groups were matched (1:2) by predictors of seizure remission (PSR) in adults with DRE. A systematic review of the literature was conducted to establish PSR. A total of 127 patients were eligible. Forty-six participants (36 %) initiated the MAD, but only 28 (22 %) continued the diet after 3 months. The number of past and new ASMs, epilepsy type, and follow-up time were selected as PSR. Twelve patients were included in the diet group and 24 in the control group, matched by PSR. Compared with the control group, the diet group had 4.5 greater odds of achieving ≥50 % seizure frequency reduction at 1-3 months (OR 5.5; 90 % confidence interval 1.1-26.65). Mean seizure frequency and other secondary outcomes did not differ significantly between the groups. In summary, the MAD showed a modest effect over seizure control compared with only ASM. Matching by PSR could be an alternative analysis approach to determine the effectiveness of the ketogenic diet in controlled studies. Additional studies are required to validate the analysis proposed.

Factors associated with initiation of the modified Atkins diet in adults with drug-resistant epilepsy.

Ketogenic diets are promising therapies for drug-resistant epilepsy (DRE). Diet adherence is a major concern in adults, so a less restrictive diet like the modified Atkins diet (MAD) is preferred. The objective of this study was to explore factors associated with MAD initiation in adults with DRE. It is a retrospective cohort study that includes participants aged ≥ 16 years with at least two failing antiseizure medications (ASM). We compared clinical and demographic variables between those patients who initiated the MAD and those who did not. A total of 136 patients were included and 52 participants initiated a MAD. After 3 months, only 28 patients (58%) continued on the MAD. For those who initiated a MAD trial: 1) the average number of current ASMs (3 ±â€¯1 vs 2 ±â€¯1, p < 0.008) and the average lifetime ASMs (6 ±â€¯3 vs 5 ±â€¯2, p < 0.008) was higher, 2) they had an earlier age of epilepsy onset (9 vs 13 years, p < 0.006) and 3) there was a greater proportion of patients with a history of status epilepticus (OR = 3.89, 95% CI = 1.16-13.01). In contrast, temporal lobe epilepsy onset had a negative association with MAD trial initiation (OR = 0.32, 95% CI = 0.12-0.88). In conclusion, five factors are associated with MAD initiation in adults with DRE. Chronic DRE may be the major motivation for MAD initiation. Nonetheless, adults with a history of status epilepticus could be a target population to initiate the MAD early.