Modified Atkins diet as a treatment of epilepsy in 23 children

Alternatively to the classical ketogenic diet (KD), the modified Atkins (MAD) diet is used in the United States since 2002 for treating therapy resistant epilepsies. It is a particular ketogenic diet with administration of only 10g carbohydrates per day and unlimited calories, protein and fat. The MAD is less restrictive, and therefore more accepted in school-age children and adolescents.

During 2/2007 to 11/2010 we established the MAD in 23 children (7 female and 16 male) with focal epilepsy in 14, generalized in 6 and unclassified in 3. The patients were treated with average 11 AED before. The mean age at commencement of MAD was 8,9 years, the mean duration of epilepsy 6,2 years. The follow up period was 1 to 24 months, on an average 5,4 months.

8 children are currently under therapy with MAD, 6 during 3 and 2 patients during 11 months. 8/15 patients stopped the MAD during the first 3 months (twice on account of non-compliance), 5/15 during the first 6 months; one stopped the diet being seizure free after 2 years. 4 patients were switched to KD without any benefit.

The results of our children were presented and discussed in comparison with the literature. These are not as positive as reported. Possible reasons were pointed out. As in the literature, we got positive results with children with myoclonic-astatic epilepsy (MAE). One boy with MAE (1/5) became seizure free for 2 years, and currently is. 2 other patients have a responder rate >90%. Another patient was put on MAD by the mother herself and shows a seizure reduction of >75% exceeding 9 months.

Although our numbers of cases are small, a comparison with the literature is difficult, and even if the responder rate is not equivalent to the literature, it can be pointed out that there is a good response of MAD in MAE (4/24; a responder rate of >90% in 16,6%).