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For Pediatric Drug-Resistant Epilepsy, Modified Atkins May Be Best Dietary Intervention
Although the ketogenic diet, modified Atkins diet, and low glycemic index therapy were each more effective than care as usual for short-term seizure reduction in childhood drug-resistant epilepsy, the modified Atkins diet may be the most sound dietary option, according to a network meta-analysis published online ahead of print in JAMA Pediatrics.
The review and meta-analysis included 12 randomized clinical trials that compared the three dietary therapies with each other or care as usual in 907 patients with childhood drug-resistant epilepsy.
For 50% or higher seizure reduction in 3 months or less, all dietary interventions were more effective than care as usual, according to the study. The ketogenic diet and the modified Atkins diet, however, were better than low glycemic index therapy and care as usual for 90% or higher seizure reduction, and even 100% seizure reduction, in 3 months or less.
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The study also found that adverse event–related diet withdrawal rates were significantly higher for ketogenic diet, followed by the modified Atkins diet, compared with care as usual.
“Hence, the modified Atkins diet with better tolerability and a higher probability for 50% or higher seizure reduction and comparable probability for 90% or higher seizure reduction and seizure freedom appears to be a sounder option than the ketogenic diet,” wrote first author Nagita Devi, PhD, of the National Institute of Pharmaceutical Education and Research in Punjab, India, and coauthors.
Common reasons for discontinuation of dietary interventions were a lack of effectiveness, parental unhappiness, and food refusal. Both the ketogenic and modified Atkins diets were associated with hypercalciuria, dyslipidemia, and gastrointestinal adverse events. The ketogenic diet was also linked with serious adverse events and lower tolerability for prolonged duration.
“There was a paucity of studies focusing on intermediate and long-term outcomes of the ketogenic diet, modified Atkins diet, and low glycemic index therapy,” researchers advised. “Direct head-to-head comparison studies in the future are needed to confirm these findings further.”
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