3 diets have varied pros, cons in treating drug-resistant epilepsy in children

  • JAMA Pediatr
  • 3 Aug 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • 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

Key results

  • 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%).

Study design

  • Indian noninferiority randomized clinical trial, 170 children aged 1-15 years:
    • ≥4 seizures per month.
    • Not responding to ≥2 antiseizure drugs.
  • Randomization:
    • 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.

Limitations

  • Larger standard deviations.
  • Inability to blind all participants.
  • Some seizures were likely missed.