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SEATTLE– Most pediatric patients with intractable epilepsy fare similarly well if they follow the less-restrictive modified Atkins diet instead of the classic ketogenic diet, new data suggest. The former may be better in patients with kidney disease, whereas the latter may be better for very young children.
“The modified Atkins diet is much easier to follow, and many physicians think that it shows much lower [rates of] complications. But until now, there have been very few studies comparing the ketogenic diet and modified Atkins diet,” lead investigator Dr. Jeong-A Kim commented in an interview at the annual meeting of the American Epilepsy Society, where she presented the findings.
The investigators conducted a randomized trial pitting the two diets against each other among 104 patients aged 1-18 years who had drug-refractory epilepsy and had never received dietary therapy.
The proportion of patients free of seizures, defined as having none for at least the past month, did not differ significantly overall between the ketogenic diet and modified Atkins diet groups at 3 months (32.7% vs. 26.4%) or at 6 months (29.4% vs. 20.7%), according to results reported in a poster session. There was also no significant difference in the proportions achieving a greater than 50% reduction and a greater than 90% reduction in seizures.
In stratified analyses, the findings were similar for most age groups, except for children 1 or 2 years old, who had a significantly higher rate of freedom from seizures at 3 months if they were on the ketogenic diet (17.6% vs. 7.5%; P = .047).
The diets were statistically indistinguishable with respect to rates of most adverse effects, but hypercalciuria was twice as common with the ketogenic diet (35.3% vs. 13.2%; P = .01). Also, a larger share of patients in the ketogenic diet group stopped their diet because of adverse effects.
“I usually first try the ketogenic diet, but if the patients show some side effects such as hypercalciuria or GI trouble, something like that, then I usually change it to the modified Atkins diet,” commented Dr. Kim, who is a pediatric neurologist at Severance Children’s Hospital, Yonsei University Health System, in Seoul, South Korea.
Clinicians should know “You have choices when you think about dietary therapy: It’s not just the ketogenic diet, you also have choices such as the modified Atkins diet,” she maintained. “So if a patient has kidney problems or some other problems, then you can try the modified Atkins diet instead of the ketogenic diet. You don’t have to have prejudices or misconceptions about dietary therapy; you also have other options for dietary therapy.”
“For younger patients who have Lennox-Gastaut syndrome or infantile spasms, it would be better to try the ketogenic diet first,” advised Dr. Kim, who disclosed that she had no relevant conflicts of interest.
