Abstracts

The ketogenic diet is not typically offered to adults with epilepsy due to the significant lifestyle alterations needed for its use. The modified Atkins diet has been recently demonstrated to be therapeutic for children with intractable epilepsy without the need for admission, weighing foods, and fluid, calorie, and protein restrictions. We hypothesized the modified Atkins diet would be similarly well tolerated and effective for adults., Study inclusion criteria included age over 18, and at least weekly seizures and 2 attempted anticonvulsants. Carbohydrates were initially restricted to 15 grams/day, fats encouraged, and fluids, protein, and calories were ad lib. Medications were unchanged for the first 3 months. Patients were examined and laboratory results obtained at baseline, 1, 3, and 6 months on the diet., Thirty patients, median age 36 years (range, 18 to 53), 19 (63%) female, consented and 29 started the diet. The median number of prior medications was 8 (range, 2-14); seizures were occurring 10 times per week (range, 1-140). Twelve patients had vagus nerve stimulators, 8 had failed resective surgery. Using an intent-to-treat analysis, approximately 40% had a [gt]50% seizure reduction after 1 and 3 months on the diet. In those with seizure reduction, the median time to improvement was 2 weeks (range, 1 week to 2 months). Improvement was slightly higher in those with moderate to large urinary ketosis at the 1-month visit, p=0.08. The mean weight loss was 6.9 kg; mean BMI decreased from 29.0 to 26.5, p=0.001. Cholesterol increased from a mean of 182 to 201 mg/dl after 1-3 months, p=0.02. Compliance was problematic; 11 (37%) discontinued the diet prior to 3 months., A modified Atkins diet appears to be an effective therapy for adults with intractable epilepsy and can also induce weight loss. Considering the high dropout rate, a 2-month trial appears to be adequate., (Supported by General Clinical Research Center, NIH/National Center for Research Resources grant M01-RR00052.)