The Modified Atkins Diet (MAD) has emerged as an adjuvant therapy in drug-resistant epilepsy (DRE). Most studies are in children, there is limited evidence of DRE in adults.
The present study aimed to investigate whether MAD together with standard drug therapy (SDT) was indeed more effective than SDT alone in reducing seizure frequency and improving psychological outcomes at 6 months in adolescents and adults with DRE (non-surgical ).
A prospective randomized controlled trial was conducted at a tertiary care referral center in India. People with EDR aged 10 to 55 years who attended outpatient epilepsy clinics between August 2015 and April 2019, who had more than two seizures/month despite using at least three appropriate antiseizure medications (ASM) at their maximum tolerated doses and had not been on any form of dietary therapy for the past year, were enrolled.
Patients were assessed for eligibility and randomly assigned to receive SDT plus MAD (intervention arm) or SDT alone (control arm). , behavior, adverse events and withdrawal rate at six months. An intention-to-treat analysis was performed.
243 patients were evaluated for eligibility; 160 patients (80 adults and 80 adolescents) were randomized to the intervention or control arm. Demographic and clinical characteristics in both groups were comparable at baseline.
At six months, a >50% reduction in seizures was observed in 26.2% in the intervention group versus 2.5% in the control group (95% CI: 13.5-33.9 ; p<0.001). The improvement in QOL was 52.1±17.6 in the intervention group versus 42.5±16.4 in the control group (mean difference, 9.6; 95% CI: 4.3 to 14.9, p<0.001).
However, behavioral scores could be performed on 49 patients and improvement was observed in the intervention group versus the control group (65.6 ± 7.9 versus 71.4 ± 8.1, p = 0.015) at the end. of the study. One patient had weight loss; two patients had diarrhea.
The MAD group demonstrated improvement in all aspects (reduced seizure frequency and behavioral problems) compared to the control group at the end of the study. MAD is an effective modality in seizure control, further research is required to evaluate its efficacy in terms of biomarkers along with descriptive metabolomics studies.
According to a study published in Neurology® , the medical journal of the American Academy of Neurology: "For people with drug-resistant epilepsy, or those who have been unable to find an effective treatment to reduce seizures, it is encouraging to see "There are lifestyle changes that can be combined with standard drug therapy to reduce the number of seizures," said study author Manjari Tripathi, MD, DM, of the All India Institute of Medical Sciences in New Delhi. “Our study found that this combination can reduce the chance of seizures by more than half.”
The modified Atkins diet is a combination of the Atkins diet and a ketogenic diet that includes foods such as soy products, heavy cream, butter and oils, leafy green vegetables, and animal protein, including eggs, chicken, fish, and bacon. While the ketogenic diet has been shown to be effective in reducing seizures, its strict requirements and restrictions can make it difficult to follow.
The study involved 160 adults and adolescents who had epilepsy for more than 10 years on average and had at least 27 seizures per month despite trying an average of four anti-seizure medications at the maximum tolerated dose. They were randomly assigned to receive standard drug therapy alone or drugs plus the modified Atkins diet for six months.
Participants recorded their seizures and meals. They were given food lists, sample menus and recipes. Carbohydrate intake was restricted to 20 grams per day. Federal dietary guidelines recommend between 225 and 325 grams of carbohydrates per day.
After six months, researchers found that 26% of people who received drug therapy and followed the modified Atkins diet had a more than 50% reduction in seizures compared to just 3% of people who only received drug therapy. Four people in the diet group were seizure-free at the end of the study, while no one in the medication-only group was seizure-free.
The study also looked at quality of life, behavior and side effects at six months. The group that received drug therapy and followed the modified Atkins diet showed improvement in all areas compared to the group that only received drug therapy.
Tripathi noted that 33% of participants did not complete the study due to poor tolerance of the diet, lack of benefit, or inability to follow up in part due to COVID-19. However, Tripathi said the tolerance of the modified Atkins diet was better than that seen with the ketogenic diet.
"While the modified Atkins diet may be an effective treatment for controlling seizures, more research is needed to identify genetic biomarkers and other factors associated with response to this diet," Tripathi added. "This may improve patient care by encouraging specific accuracy based on previous use of this diet."
A limitation of the study is that seizures were self-reported or caregiver-reported, so some seizures may not have been reported.
The study was supported by the Department of Biotechnology of India.
