— With better tolerability, modified Atkins diet the “sounder option,” according to researchers
In children with drug-resistant epilepsy, the modified Atkins and ketogenic diets were more effective than usual care in achieving large short-term reductions in seizures and short-term seizure freedom, a systematic review and network meta-analysis found.
Across 12 randomized trials, all three dietary interventions evaluated — ketogenic, modified Atkins, low glycemic index therapy (LGIT) — showed a short-term benefit (3 months or less) in seizure reductions of at least 50% compared with usual care, reported Dipika Bansal, DM, of the National Institute of Pharmaceutical Education and Research in Punjab, India, and colleagues.
But as described in JAMA Pediatricsopens in a new tab or window, only the modified Atkins and ketogenic diets were effective for short-term seizure reductions of 90% or more compared with usual care and for achieving short-term freedom from seizures.
These may be more meaningful outcomes for children with a very high burden of daily seizures, such as those with drug-resistant epilepsy, according to the researchers.
While direct comparisons showed no significant differences, they concluded that with its better tolerability, the modified Atkins diet “may be a sounder option than ketogenic diet.”
Across dietary interventions, pooled results showed that 36% of children achieved short-term seizure reductions of 50% or more, 17% had reductions of 90% or more, and 10% achieved short-term seizure freedom. Data on intermediate outcomes were more mixed and only one study examined long-term outcomes.
Modified Atkins and ketogenic diets were both associated with more adverse event-related discontinuations versus usual care. Adverse events included constipation, lack of energy, and vomiting.
Participants also withdrew from the diets for reasons including “inefficacy, parental unhappiness, behavioral food refusal, dissatisfaction with randomization results, and food texture,” Bansal and co-authors noted. “This echoes with the fact that parental food habits opens in a new tab or window and feeding strategies determine their child’s eating behavior.”
Dietary therapies have long been used to treat the nearly 30% of pediatric epilepsy patients who are resistant to antiseizure medication, but investigations into the comparative efficacy of various interventions, along with their safety, have been lacking.
“Although epilepsy surgery is a curative treatment option for surgically amenable DRE [drug-resistant epilepsy], alternative modalities such as dietary therapies are often used on the failure of two or more appropriately chosen antiseizure medications while awaiting epilepsy surgery, in nonsurgical DRE, and specific neurometabolic disorders,” wrote Bansal and colleagues.
In addition to patient-specific factors such as primary diagnosis and child/family dietary preferences, selection of a drug-resistant epilepsy diet should take into account the interactions of different dietary therapies, including the possible adverse effects of carbonic anhydrase inhibitors and valproic acid in patients on a ketogenic diet, the group advised.
Source: medpagetoday.com, Kate Kneisel
