Both the ketogenic and modified Atkins diets are effective treatment modalities for children with refractory epilepsy of genetic etiology, demonstrating good tolerability and relatively few adverse effects. A single-center, retrospective study on the subject was conducted, results of which were published in Pediatric Neurology.

The investigators sought to evaluate the efficacy and tolerability of the ketogenic diet and modified Atkins diet in pediatric patients with refractory epilepsy of genetic etiology, exploring the effect of the dietary therapy on the frequency of seizures. Records of children with a genetic etiology for refractory epilepsy who were treated with the ketogenic diet and modified Atkins diet between September 2005 and July 2016 were reviewed. Age at seizure and diet onset, seizure characteristics, and specific genetic etiology were documented. The researchers noted the proportion of children who remained on the diet and the responder rates (>50% seizure reduction) at 1, 3, 6, 12, and 24 months after initiation of the dietary therapy. Safety and tolerability profiles were recorded as well.

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A total of 59 children with a genetic etiology for epilepsy (63% girls; median age, 2.2 years at diet onset) were initiated on the diet at the study center. Overall, 90% (53 of 59) of patients were started on a traditional ketogenic diet, whereas 10% (6 of 59) began a modified Atkins diet. Furthermore, 48% (28 of 59) of the participants remained on the diet at the end of 24 months.

Adverse events reported most often at the initiation of the diets included vomiting (24%), hypoglycemia (15%), and refusal to feed (11%). Moreover, 3 children discontinued the diet before discharge because of poor compliance, ketoacidosis, and severe reflux (n=1 for all).

The proportion of children who remained on the diet at 1, 3, 6, 12, and 24 months were 95%, 86%, 69%, 64%, and 47%, respectively. Responder rates at the same times were 63%, 61%, 54%, 53%, and 41%, respectively.

The investigators concluded that the ketogenic and modified Atkins diets are an effective treatment modality for children with refractory epilepsy of genetic etiology. For the most part, any adverse effects encountered can be managed with close monitoring and follow-up. In patients who are <2 years of age, it is recommended that the diet be initiated in the hospital, as the patients require frequent glucose monitoring. Additional randomized controlled studies with a larger cohort are warranted to confirm these findings.

Reference

Jagadish S, Payne ET, Wong-Kisiel L, Nickels KC, Eckert S, Wirrell EC. The ketogenic and modified Atkin’s diet therapy for children with refractory epilepsy of genetic etiology [published online December 23, 2018]. Pediatr Neurol. doi: 10.1016/j.pediatrneurol.2018.12.012