Abstracts

Rationale: A modified Atkins diet is a less restrictive alternative to the ketogenic diet, which allows unlimited protein, fat, calorie, or fluid intake. Also it is started on an outpatient basis without a fast. In this study, we aimed to evaluate the efficacy, tolerability and compliance of a modified Atkins diet for intractable pediatric epilepsy. Methods: We retrospectively reviewed the medical records of 26 pediatric patients (10 males, 16 females) with intractable epilepsy who were treated with a modified Atkins diet at Samsung Medical Center from January 2011 to March 2016. Results: The mean age at diet initiation was 10.9 years (range, 2 – 21). The average age at seizure onset was 5 years (range, 0.1 – 14). Patients were receiving a mean of 4.2 antiepileptic drugs at diet onset (range, 2 – 7). Many different seizure types were represented, including multiple (n = 11), complex partial (n = 9), spasms (n = 2), generalized tonic clonic (n = 2), atonic (n =1), and myoclonic (n =1). The diet was continued for a mean duration of 5.9 months (range, 1 – 16). At 6 months, for those still on a modified Atkins diet (n = 10), 6 (60%) had >50% seizure reduction and 2 (20%) were seizure-free. More than one type of generalized seizures were predominantly observed in this group. (p < 0.05). Four of 26 patients (15.4%) reported side effects during the diet, which included constipation (n = 2) and elevations in lipid profile (n = 2). Mean body mass index was reduced from 22.6 to 20.9 (p = 0.011) in patients who were on diet at 3 months (n = 13). Four of these patients were overweight before initiating the diet and were satisfied with body mass index changes from a mean of 30.3 to 27 (p = 0.042). Twelve patients (46.2%) discontinued the diet for various reasons, including food refusal (n = 3), poor parental compliance (n = 3), no profound effect on seizure reduction and poor compliance of patients or parents (n = 2), other medical conditions which were not attributable to the diet (n = 2), sudden unexpected death in epilepsy (n = 1), and loss of follow-up (n = 1). Conclusions: A modified Atkins diet is generally well-tolerated and may serve as an alternative treatment for children with multiple types of generalized seizures. Food refusal and poor parental compliance were common reasons for cessation of the diet. Team approach consisting of neurologist, dietitian, social worker, and motivated family is mandatory for maintaining a modified Atkins diet. Funding: No