- The modified Atkins and low glycemic index therapy diets were not inferior to the ketogenic diet for percentage reduction in seizure frequency among children with drug-resistant epilepsy, but median reductions were similar.
- Adverse events were least frequent with low glycemic index therapy diet.
Why this matters
- Adherence to ketogenic diet can be difficult.
- 24-week median change in seizure frequency was similar (P=.39):
- Ketogenic diet: −66%.
- Modified Atkins diet: −45%.
- Low glycemic index therapy diet: −54%.
- Median difference in seizure reduction, ketogenic diet vs:
- Modified Atkins diet: −21 (95% CI, −29 to 3) percentage points.
- Low glycemic index therapy diet: −12 (95% CI, −21 to 7) percentage points.
- Treatment-related adverse events vs ketogenic diet (56.4%):
- Similar for modified Atkins diet (56.9%).
- Lower for low glycemic index therapy diet (33.3%).
- Indian noninferiority randomized clinical trial, 170 children aged 1-15 years:
- ≥4 seizures per month.
- Not responding to ≥2 antiseizure drugs.
- Ketogenic diet (goal 4:1 lipids:nonlipids).
- Modified Atkins diet (Johns Hopkins protocol).
- Low glycemic index therapy diet (restricting high-glycemic index foods, limiting carbohydrates to ~10% daily calories).
- Main outcome: percentage change in seizure frequency (noninferiority margin: −15 percentage points).
- Funding: None disclosed.
- Larger standard deviations.
- Inability to blind all participants.
- Some seizures were likely missed.