Abstracts

Rationale: There is a growing body of evidence from the pedeatric population suggesting that a diet that severely restricts carbohydrate intake may be helpful in reducing the frequency of pharmacoresistant seizures. The Atkins diet is a diet that has been popularized in the media and also requires severe carbohydrate restriction. This diet is less complex than a traditional ketogenic diet, and therefore may be associated with greater compliance in adult populations. This study purports to contribute to previous work in this field intended to determine (1) if the Atkins Diet is an effective and sustainable method of co-therapy in intractable epilepsy in an adult population and (2) whether compliant patients show health gains in the form of weight reduction beyond greater seizure control. Methods: Patients with medically refractory epilepsy who were not candidates for resection surgery were invited to participate in the study. They were given information about the Atkins diet by a dietician, and were instructed to keep detailed food intake and seizure diaries. Dietary follow-ups were done with reinforcement of instructions and verification of ketosis, as well as measurement of weight and self-reported seizure frequency after one month, and then every three months thereafter for a total of 12 months. Medical visits and pharmacotherapy were modified in accordance with best medical practice at the discretion of the treating epileptologist. Results: Eighteen eligible patients signed consent. Of these, four withdrew secondary to financial or logistical difficulties. Most of the patients who agreed to participate were overweight and had focal seizures with or without generalization. Of the 14 patients who completed the study, ketosis (i.e., compliance) was only confirmed in seven after six months and in six after 12 months. Twelve patients witnessed a decrease in weight over the course of the study; the remaining two were not being encouraged to lose weight and were consuming increased calories to compensate. Six patients reported a reduction in seizure frequency over the course of the study; of the remaining eight, six reported an increase in seizure frequency and two reported no change. Conclusions: The Atkins diet may prove beneficial in reducing seizure frequency, when combined with optimal pharmacotherapy, in the management of certain patients with intractable epilepsy, even if adherence to the diet is imperfect. Importantly, several patients did report an increase in seizure frequency, even though adherence to the diet was confirmed via evidence of urinary ketosis, and was similar to that seen in participants reporting a reduction in seizure frequency. Patient recruitment also proved challenging, despite the popularity of this diet in the media. Several patients who had initially agreed to participate later dropped out of the study, reporting that the diet procured too many financial and logistical obstacles. This study sample is too small and the follow-up period too short to derive useful recommendations at this time.