Sequential Treatment with Modified Atkins Diet and Low Glycemic Index Treatment for Drug-Resistant Epilepsy in Children

Abstract

Objectives The present study was designed to study the efficacy of sequential dietary therapy with a modified Atkins diet (mAD) followed by low glycemic index treatment (LGIT) in treating drug-resistant epilepsy in children.

Methods This interventional study was conducted from February 2021 to February 2022 among children aged 6 months to 5 years who had failed to respond to more than two conventional and correctly chosen antiseizure medications. The primary endpoint was the proportion of good responders, that is, children with more than 50% seizure reduction. Secondary outcome measures were the proportion of children with seizure freedom, > 90% seizure reduction, and the nature of parent-reported adverse events.

Results A total of 45 children were recruited for the study, with 6 children being lost to follow-up at 12 weeks. At 12 weeks, 30 of 39 (76.9%) children were good responders with more than 50% seizure reduction. Of these 30 children, 11 (24.4%) had more than 90% seizure reduction, with 9 (20%) achieving complete spasm freedom. Constipation was the most common side effect of the diet among the enrolled subjects.

Conclusion Clinicians can consider sequential dietary therapy with a mAD in the first month followed by LGIT in the next 2 months for treating children who could not tolerate mAD beyond 1 month.

Keywords

infantile spasms - Lennox–Gastaut syndrome - drug-resistant epilepsy - ketogenic diet

Ethical Approval

An institutional ethical approval was obtained before the commencement of the study.

Authors' Contributions

J.S.K.: Concept and design of the study; A.M., S.D., J.S.K.: data collection, analysis, and interpretation of data; J.S.K., A.M.: drafting the manuscript and review of literature; J.S.K., S.D., A.M.: critical review of the manuscript for intellectual content and final approval of the version to be published; J.S.K.: clinician-in-charge, critical review of the manuscript for intellectual content, final approval of the version to be published, and will act as guarantor for the paper. All authors approve of the final version.

Publication History

Received: 23 March 2024

Accepted: 21 May 2024

Article published online:
21 June 2024

• References

• 1 Kossoff EH, Zupec-Kania BA, Auvin S. et al. Charlie Foundation, Matthew's Friends, Practice Committee of the Child Neurology Society. Optimal clinical management of children receiving dietary therapies for epilepsy: updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open 2018; 3 (02) 175-192
• 2 Sharma S, Sankhyan N, Gulati S, Agarwala A. Use of the modified Atkins diet for treatment of refractory childhood epilepsy: a randomized controlled trial. Epilepsia 2013; 54 (03) 481-486
• 3 Miranda MJ, Mortensen M, Povlsen JH, Nielsen H, Beniczky S. Danish study of a modified Atkins diet for medically intractable epilepsy in children: can we achieve the same results as with the classical ketogenic diet?. Seizure 2011; 20 (02) 151-155
• 4 Kossoff EH, Dorward JL. The modified Atkins diet. Epilepsia 2008; 49 (Suppl. 08) 37-41
• 5 Kossoff EH, Cervenka MC, Henry BJ, Haney CA, Turner Z. A decade of the modified Atkins diet (2003–2013): Results, insights, and future directions. Epilepsy Behav 2013; 29 (03) 437-442
• 6 Grocott OR, Herrington KS, Pfeifer HH, Thiele EA, Thibert RL. Low glycemic index treatment for seizure control in Angelman syndrome: a case series from the Center for Dietary Therapy of Epilepsy at the Massachusetts General Hospital. Epilepsy Behav 2017; 68: 45-50
• 7 Sondhi V, Sharma S. Non-pharmacological and non-surgical treatment of refractory childhood epilepsy. Indian J Pediatr 2020; 87 (12) 1062-1069
• 8 Krauss GL, Sperling MR. Treating patients with medically resistant epilepsy. Neurol Clin Pract 2011; 1 (01) 14-23
• 9 Sondhi V, Agarwala A, Pandey RM. et al. Efficacy of ketogenic diet modified Atkins diet, and low glycemic index therapy diet among children with drug-resistant epilepsy: a randomized clinical trial. JAMA Pediatr 2020; 174 (10) 944-951
• 10 Park EG, Lee J, Lee J. Use of the modified Atkins diet in intractable pediatric epilepsy. J Epilepsy Res 2018; 8 (01) 20-26
• 11 Kim SH, Kang HC, Lee EJ, Lee JS, Kim HD. Low glycemic index treatment in patients with drug-resistant epilepsy. Brain Dev 2017; 39 (08) 687-692
• 12 Kaushik JS, Patra B, Sharma S, Yadav D, Aneja S. Clinical spectrum and treatment outcome of West Syndrome in children from Northern India. Seizure 2013; 22 (08) 617-621
• 13 Tonekaboni SH, Mostaghimi P, Mirmiran P. et al. Efficacy of the Atkins diet as therapy for intractable epilepsy in children. Arch Iran Med 2010; 13 (06) 492-497
• 14 Muzykewicz DA, Lyczkowski DA, Memon N, Conant KD, Pfeifer HH, Thiele EA. Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy. Epilepsia 2009; 50 (05) 1118-1126
• 15 Gupta S, Dabla S, Kaushik JS. Modified Atkins diet vs low glycemic index treatment for drug-resistant epilepsy in children: an open label, randomized controlled trial. Indian Pediatr 2021; 58 (09) 815-819
• 16 Karimzadeh P, Sedighi M, Beheshti M, Azargashb E, Ghofrani M, Abdollahe-Gorgi F. Low glycemic index treatment in pediatric refractory epilepsy: the first Middle East report. Seizure 2014; 23 (07) 570-572
• 17 Lakshminarayanan K, Agarawal A, Panda PK. et al. Efficacy of low glycemic index diet therapy (LGIT) in children aged 2-8 years with drug-resistant epilepsy: a randomized controlled trial. Epilepsy Res 2021; 171: 106574
• 18 Coppola G, D'Aniello A, Messana T. et al. Low glycemic index diet in children and young adults with refractory epilepsy: first Italian experience. Seizure 2011; 20 (07) 526-528