September 3, 2020

Comparison of the Ketogenic Diet, Modified Atkins Diet, and Low Glycemic Index Therapy Diet Among Children with Drug-Resistant Epilepsy

Abstract, published in JAMA Pediatrics

Objectives: The ketogenic diet (KD) has been used successfully to treat children with drug-resistant epilepsy. Data assessing the efficacy of the modified Atkins diet (MAD) and low glycemic index therapy (LGIT) diet, compared with the KD are scarce. The purpose of this study was to determine whether the MAD and LGIT diets, which are often easier to follow, are as effective as the KD among children with drug-resistant epilepsy.

Design, setting, and participants: One hundred seventy children aged between 1 and 15 years who had 4 or more seizures per month, had not responded to 2 or more antiseizure drugs, and had not been treated previously with the KD, MAD, or LGIT diet were enrolled between April 1, 2016 and August 20, 2017 at a tertiary care referral center in India. Children were randomly assigned to receive the KD, MAD, or LGIT diet as additions to ongoing therapy with antiseizure drugs.

Results: One hundred fifty-eight children completed the trial: KD (n = 52), MAD (n = 52), and LGIT diet (n = 54). Analysis showed that, after 24 weeks of the interventions, the proportion of children with greater than 50% seizure reduction was 67.3% with the KD, 51.9% with the MAD, and 59.3% with the LGIT diet. Treatment-related adverse events were similar between the KD and MAD but were significantly less in the LGIT diet.

Conclusions: Data from this study showed that all 3 dietary regimens – KD, MAD, and the LGIT diet – significantly reduce seizure burden. Importantly, the LGIT diet showed a balance between seizure reduction and relatively fewer adverse events compared with the KD and MAD. These potential benefits suggest that the risk-benefit decision regarding the 3 diets needs to be individualized.

Related News