A Safe and Effective Diet for Treating Drug-Resistant Epilepsy

A recent study showed that the diet showed short-term efficacy against drug-resistant epilepsy (DRE) in children, but the ketogenic diet (KD) was well tolerated compared to the modified Atkins diet (MAD). has been shown to be bad.

Nearly 30% of children with epilepsy experience DRE. DRE is a form of epilepsy that is currently difficult to treat. DRE can often be treated with epilepsy surgery, but dietary therapy may be used if two or more of the antiepileptic drugs of choice do not work in a child awaiting surgery.

KD has shown promising results limited by adherence difficulties in past centuries. More recently, less restrictive options such as the Modified Atkins Diet (MAD) and Low Glycemic Index Therapy (LGIT) have been explored.

Due to the need to investigate the comparative safety and efficacy of these diets in treating DRE, researchers conducted a meta-analysis on this subject.

A preliminary search was performed using PubMed, Embase, Cochrane, and Ovid databases by entering keywords including ketogenic diet, medium-chain triglyceride diet, modified Atkins diet, low glycemic index therapy, and refractory epilepsy. Specific reference lists from GoogleScholar, ClinicalTrials.gov, and articles were used for manual searches.

Studies used in the analysis included randomized clinical trials (RCTs) that evaluated the safety and efficacy of diets such as MAD, KD and LGIT. Two authors independently screened and extracted data for the study.

Extracted variables included publication year, country, participant demographics, baseline characteristics, intervention details, reported outcomes, and other relevant information. Discrepancies between the two authors were discussed and consulted with the third author.

A significant reduction in seizure rate was measured as the primary outcome of the analysis. This was measured by percentage reduction in short-term seizures of 50% or greater or 90% or greater. Intermediate and long-term seizure freedom were also assessed.

Safety outcomes measured included treatment discontinuations due to adverse events (AEs) and other reported AEs.

There were 11 open-label RCTs and 1 single-blind RCT comparing the three diets with each other, or usual care, included in the analyses. In these studies, 676 patients were assigned to dietary interventions and 257 to usual care. A common patient group was found between the two studies, and a total of 907 participants were included in the study.

The average age of participants at enrollment was 4.6 years and 67% of the participants were boys. The patient’s mean age of seizure onset was 1.4 years, and his mean seizure rate was 27.1 per day. Results at 3 months were assessed in 9 trials, 5 trials at 4-6 months and 1 trial at 12 months.

All three diets were more than 50% more effective in reducing seizures than usual care.No significant differences were found among the three diets. More patients reached more than 90% seizure reduction when taking MAD or KD compared to usual care, but the two diets showed no significant difference from each other.

Ten percent of patients on the diet were seizure free, with KD and MAD being more consistently seizure free. There were no significant differences between these diets.

Participants were significantly more likely to discontinue treatment due to AEs when taking KD or MAD compared to standard care. These discontinuation cases were not significantly different from each other.

Common AEs from KD include constipation, lack of energy, vomiting, hunger, diarrhea, hypercalciuria, abdominal pain, and dyslipidemia. Common AEs from MAD include constipation, low energy, vomiting, anorexia, dyslipidemia, and hypercalciuria.

Overall, MAD is well tolerated, may reduce seizures by more than 50%, and may reduce seizures by more than 90%, making it the most reasonable option for DRE management.

reference

Devi N, Madaan P, Kandoth N, Bansal D, Sahu JK. Effectiveness and safety of dietary therapy for childhood drug-resistant epilepsy: a systematic review and network meta-analysis. JAMA Pediatrics 2023. doi:10.1001/jamapediatrics.2022.5648