Abstracts

Rationale: The modified Atkins diet ( MAD) consists of a nearly balanced diet, 60% fat, 30% protein, 10% carbohydrate by weight, than ketogenic diet (KD). The MAD is more palatable and less restrictive than the KD. There has been a marked increase in the use of the MAD in the treatment of epilepsy. Over the last 8 years, evidence suggesting that the MAD may exhibit similar anticonvulsant properties as the traditional KD has been accumulating, retrospectively. However, there are no randomized controlled trial studies comparing the KD with MAD. The aim of this study was to evaluate the efficacy of the MAD compared with KD in children with refractory epilepsy in a randomized controlled trial.Methods: The open-label, randomized-controlled trial was conducted in the Pediatric Epilepsy Clinic, Severance Children's Hospital between March 2011 and March 2013. 108 children aged between 2 and 16 years who had at least one seizure per week (or more than four seizures per month), had failed to respond to at least two antiepileptic drugs, and had not been treated previously with the diet therapy. Children were randomly assigned to receive a KD or MAD as Severance hospital diet protocol. Children were evaluated at starting the diet and followed after 1, 3, and 6 month on the outpatient clinics. The primary endpoint was a reduction in seizures at 6 months on diet. Results: 54 children were assigned to the KD and 54 children to the MAD. Data from 77 children were available for analysis: 42 on the KD and 35 on the MAD. After 6 months, 26 children (61%) in the KD group had greater than 50% seizure reduction compared with 14 (40%) in the MAD group (p=0.660), and 17 children (40%) in the KD group had greater than 90% seizure reduction compared with 13 (37%) in the MAD group (p= 0.829). Twelve children (29%) in the KD and 10 children (29%) were seizure free. After 3 months on the MAD, six children switch to the KD from the MAD: 4 children; effective on the MAD, but not enough, 2 children; no effective on the MAD. The three children who stopped the KD because of complications: persistent metabolic acidosis, hyperclacemia, kidney stone. There was no patients require discontinuation of the MAD.Conclusions: The MAD may be slightly less efficacious compared with the KD. But there was no statistical significance. The MAD can be used as a first dietary treatment for the patients who were benefited from diet therapy.