Abstracts

Rationale: The modified Atkins diet (MAD) is a less restrictive version of the traditional ketogenic diet (KD), both of which are used for intractable epilepsy. It has been previously reported that children can maintain seizure control when the KD is transitioned to the MAD over time. What is unknown, however, is the likelihood of additional seizure control from a switch from the MAD to the KD. Methods: Retrospective information was obtained from 28 patients who made this dietary change from 4 different institutions in Denmark, Germany, South Korea, and the United States. Results: Eighteen (64%) were female, the median age at seizure onset was 2.3 years (range: 0.1-15.0 years), and MAD onset 5.5 years (range: 2.2-19.0 years). Nine (32%) had >10% additional seizure reduction with the KD above the MAD, of which 5 became seizure-free. None of the 5 children who did not improve using the MAD later responded to the KD. There was an increased likelihood of improvement if the patient had myoclonic-astatic epilepsy compared to all other etiologies combined, 78% vs. 11%, p=0.001. Additionally, all five children who became seizure-free only after transitioning to the KD had myoclonic-astatic epilepsy. A trend towards greater likelihood of improvement if a child was fasted at KD onset was identified, but it did not reach statistical significance (78% vs. 42%, p=0.09). Conclusions: These results suggest the KD probably represents a higher dose of dietary therapy compared to the MAD, rather than unique diets. The switch from the MAD to the KD may particularly benefit those with myoclonic-astatic epilepsy.