Abstracts

Rationale: Adults with medically and surgically refractory epilepsy represent the most difficult to treat cases of epilepsy. Few options exist for further treatment of these patients as continued medical management has a success of only 5-10%. The aim of this retrospective study was to evaluate the efficacy of the Modified Atkins Diet (MAD) and the Low Glycemic Index Diet (LGID) in this super refractory adult population as an add-on treatment modality. Methods: Medical records of patients with medically intractable epilepsy who had undergone epilepsy surgery prior to the initiation of the diet, and were subsequently treated with the MAD or the LGID, were retrospectively reviewed. All patients were seen at the Dietary Treatments of Epilepsy Clinic at the Rush Epilepsy Center by an epileptologist and a registered dietitian (RD). Only patients who had undergone epilepsy surgery (resective or deep brain stimulator (DBS) implantation as part of the Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy (SANTE) trial) were included for review. All patients attended an educational session, followed by individual meetings with both the RD and epileptologist. Either the MAD or LGID was then initiated based on clinician recommendation and patient preference. Exclusion criteria included patients that 1) were not intractable, 2) had not undergone epilepsy surgery prior to initiation of the diet, 3) failed to follow-up at 3 months, 4) were deemed non-compliant, or 5) were < 17 years of age. Outcomes included the following self-reported factors following 3 months of diet therapy: 1) improvement in seizure frequency, defined as >50% improvement in seizure frequency, 2) milder seizures, defined as self-reported decrease in duration or severity of seizures, and 3) improvement in quality of life (QOL), reported as subjective improvement in mood and/or alertness. Results: A total of 17 adult patients with medically intractable epilepsy were reviewed; patients were primarily female (76%, 13/17), white (76%, 13/17), and had a mean age of 34 years (range 21-59 years). A total of 94% of patients (16/17) had resective surgery, and 12% of patients (2/16) had DBS placement, with 1 patient having both resective surgery and DBS placement. Among all patients, 76% of patients (13/17) followed MAD, and 24% of patients (4/17) followed LGID; Table 1. A total of 53% of patients (9/17) reported >50% improvement in seizure frequency. Of those reporting >50% seizure frequency improvement, 67% of patients (6/9) were on MAD, and 33% of patients (3/9) were on LGID. A total of 46% of those following MAD (6/13) and 75% of those following LGID (3/4) experienced >50% improvement in seizure frequency. Among all patients, 71% of patients (12/17) reported milder seizures, and 82% of patients (14/17) reported improvements in QOL at 3 months. Conclusions: This retrospective study suggests that both the MAD and the LGID are effective in improving seizure control and quality of life in the most refractory epilepsy patients?"those that have failed both medical and surgical intervention. This study suggests that modified ketogenic diets may represent the best chance for seizure reduction for this difficult to treat population. Future larger cohorts as well as prospective controlled studies are needed to further assess the benefits of these dietary treatments in this very refractory patient population. Funding: None