Modified Atkins diet may be better than keto for childhood drug-resistant epilepsy

Dietary modifications offer short-term benefits in children with drug-resistant epilepsy, but modified Atkins diet appears more tolerable and more likely to reduce the frequency of seizures than ketogenic diet, as shown in a study.

Researchers performed a systematic review and network meta-analysis of randomized clinical trials in which dietary therapies (ketogenic diet, modified Atkins diet, and low glycaemic index therapy) for childhood drug-resistant epilepsy were compared. An initial search through multiple online databases yielded 2,158 citations, of which 12 were included in the meta-analysis.

A total of 907 participants (mean age at enrolment 4.6 years, 67 percent boys) were included in the safety and efficacy analyses, with 664 participants randomly allocated to dietary interventions and 243 participants to care as usual.

Pooled data showed that in the short term, all dietary interventions were more likely to lead to at least a 50-percent reduction in seizures as compared with care as usual (low glycaemic index therapy: odds ratio [OR], 24.7, 95 percent confidence interval [CI], 5.3–115.4; modified Atkins diet: OR, 11.3, 95 percent CI, 5.1–25.1; ketogenic diet: OR, 8.6, 95 percent CI, 3.7–20.0).

In terms of seizure reduction of at least 90 percent, both ketogenic diet (OR, 6.5, 95 percent CI, 2.3–18.0) and modified Atkins diet (OR, 5.1, 95 percent CI, 2.2–12.0) were better than care as usual.

However, discontinuation rates due to adverse event were significantly higher for ketogenic diet (OR, 8.6, 95 percent CI, 1.8–40.6) and modified Atkins diet (OR, 6.5, 95 percent CI, 1.4–31.2) relative to care as usual.

Indirectly, the dietary therapies did not differ in efficacy and safety outcomes.

The findings suggest that modified Atkins diet may be a more attractive option than ketogenic diet for children with drug-resistant epilepsy.