Abstracts

Rationale: The Modified Atkins Diet (MAD) is a dietary treatment for intractable epilepsy that has been used successfully in adults as well as children. However, adults especially may have limited access to dietitians able to offer this therapy.Methods: A prospective, open-label, proof-of-principle 3-month study design was employed. Adults were referred by their local neurologist, consented, and enrolled via email if they qualified and had normal baseline labs. Information on how to self-administer the MAD was then emailed to the patients and they were followed by the investigators solely via email. There were no actual clinic visits or dietitian contacts during the study period.Results: Twenty-five subjects (median age 30 years (range: 18-66), 68% female) were consented, of which 22 actually started the MAD. The median prior anticonvulsants was 5 (range: 2-10) and seizure frequency was 20 per month (range: 4-560). Urinary ketosis was achieved in 21 (95%), of which 16 (76%) reported at least 40 mg/dl (moderate). Twenty-one (95%) remained on the MAD at 1 month and 14 (64%) at 3 months. After 1 month, 9 (41%) had >50% seizure reduction including 1 (5%) with >90% seizure reduction using intent-to-treat analysis. After 3 months, 6 (27%) had >50% seizure reduction including 3 (14%) with >90% seizure reduction. For those who provided 3-day MAD food records during follow-up, the mean ketogenic ratio was 1.1:1. Over the study period, the median number of emails for clarification sent by the patients was 6 (range: 1-19). Side effects included predominantly weight loss and gastrointestinal upset.Conclusions: Email administration of the MAD to adults with intractable epilepsy was feasible and effective, with dietary intake and seizure reduction similar to our previous, prospective, but in-person study. This novel method of providing dietary treatment may be advantageous in regions with limited dietitian expertise or availability.