Abstracts

The Atkins diet may induce ketosis without restrictions on calories, fluids, protein, or need for an inpatient fast and admission. Preliminary data from our institution suggests it may be effective for epilepsy. 20 children (11 female) with intractable epilepsy of various etiologies were treated with a modified Atkins diet prospectively over a 6-month study period. Carbohydrates were limited to 10 grams/day, medications were not changed, and low-carbohydrate processed foods were avoided for the first month. Parents measured urinary ketones semiweekly and recorded seizures daily. All children received vitamin and calcium supplementation. Ages ranged from 3-16 years (mean 8.1), seizure frequency 4-740 per week (mean 162), medications previously tried from 2-14 (mean 6.5), and medications at diet onset from 0-4 (mean 1.8). All children developed urinary ketosis within 4 days (mean 1.9). 16 (80%) completed the 6-month study. At 1 month, 14 (70%) had a [gt]50% reduction in seizure frequency, 4 (20%) had a [gt]90% improvement. At 6 months, 13 (65%) had a [gt]50% improvement, 7 (35%) had a [gt]90% improvement (4 seizure-free). Medications were successfully reduced in 7 patients. Ten families chose to increase carbohydrates to 15 grams/day; only one had subsequent increased seizures. Four of 5 patients with absence epilepsy had a [gt]50% improvement at 6 months (2 seizure-free). Over 6 months, mean serum BUN increased from 12 to 17 (p[lt]0.004), although creatinine did not change. Cholesterol increased slightly from 192 to 221 mg/dL, p=0.07. Urinary calcium to creatinine ratio was elevated in 8 and was treated with oral citrates; no child developed kidney stones. Weight did not significantly change (34.2 kg to 33.8 kg, p=0.94); only 5 children lost weight. A modified Atkins diet that more strictly limits carbohydrates and enhances fat consumption is an effective and well-tolerated therapy for intractable pediatric epilepsy. (Supported in part by the Dr. Robert C. Atkins Foundation.)