A systematic review and network meta-analysis found that in children with drug-resistant epilepsy, a modified Atkins diet and a ketogenic diet were more effective than usual care, resulting in significant short-term seizure reduction and short-term seizure seizure reduction. lost.
In 12 randomized trials, all three dietary interventions evaluated (ketogenic, modified Atkins, and low glycemic index therapy (LGIT)) were associated with short-term seizure reduction of at least 50% compared with usual care. (within 3 months), reported Dr. Dipika Bansal and colleagues at the National Institute of Pharmaceutical Education and Research in Punjab, India.
But as stated in JAMA Pediatrics, Only modified Atkins and ketogenic diets were effective in reducing short-term seizures by more than 90% compared to usual care (OR 5.1, 95% CI 2.2-12.0, and OR 6.5, 95, respectively). % CI 2.3-18.0). Achieve short-term freedom from seizures (OR 4.4, 95% CI 1.3-14.5 and OR 5.0, 95% CI 1.3-19.5).
According to the researchers, these may have more meaningful results for children with very high daily seizure loads, such as those with drug-resistant epilepsy.
Although no significant differences were found in direct comparisons, they concluded that the modified Atkins diet “may be a healthier option than the ketogenic diet” because it was better tolerated. attached.
Across dietary interventions, the pooled results showed that 36% of children achieved a 50% or greater reduction in short-term seizures, 17% achieved a 90% or greater reduction, and 10% achieved short-term seizure freedom. show what you have achieved. Data on intermediate outcomes were more complex, with only one study looking at long-term outcomes.
Both modified Atkins and ketogenic diets had more adverse event-related discontinuations than usual care (OR 6.5, 95% CI 1.4-31.2 and OR 8.6, 95% CI 1.8-40.6, respectively). Adverse events included constipation, lack of energy, and vomiting.
Participants also withdrew from the diet for reasons such as “inefficiency, parental unhappiness, behavioral food refusal, dissatisfaction with randomization results, and food texture”. It is consistent with the fact that eating strategies determine children’s eating behavior.”
Diet has long been used to treat nearly 30% of pediatric patients with epilepsy who are resistant to antiepileptic drugs, but studies comparing the efficacy and safety of different interventions are lacking. was
“Epilepsy surgery is a surgically applicable definitive treatment option for DRE, but [drug-resistant epilepsy]Alternative therapies, such as diet, are commonly used in nonsurgical DRE, and certain neurometabolic disorders when two or more appropriately selected antiepileptic drugs have failed while waiting for epilepsy surgery. ‘ writes Bansal and colleagues.
In addition to patient-specific factors such as primary diagnosis and child/family dietary preferences, the choice of drug-resistant epileptic diets may include various dietary interactions, such as possible side effects of carbonic anhydrase inhibitors and valproic acid. must be taken into account. Patients on a ketogenic diet, the group advised.
For a systematic review and network meta-analysis, the researchers searched 12 eligible randomized trials (11 open-label trials) in patients with drug-resistant epilepsy aged 18 years or younger, according to International League Against Epilepsy criteria. , one single-blind study). (failure of two or more appropriately selected antiepileptic drugs).
Trials were conducted in multiple countries in India, Iran, South Korea, the Netherlands, and the United Kingdom, comparing three dietary interventions to each other or to usual care, including continued use of antiepileptic drugs. Dietary interventions included a ketogenic diet (classic ketogenic diet or medium-chain triglyceride ketogenic diet). [MCT-KD]), modified Atkins, and LGIT.
Researchers say the ketogenic diet “has been used for more than a century with promising results,” but compliance issues limit its use.
“Classic KD [ketogenic diet]At a 4:1 ketogenic ratio, 80% of total energy intake comes from fat (predominantly long-chain triglycerides; medium-chain triglycerides in MCT-KD) and the rest from a combination of carbohydrates and proteins,” the authors said. The diets evaluated included modified Atkins and LGIT. These use low glycemic index foods to limit daily carbohydrate intake to 10-20 g and 40-60 g respectively, without a fixed ketogenic ratio.
Overall, 907 patients enrolled in the study were randomized (676 to dietary intervention, 257 to usual care). His two-thirds of his children were boys, and the mean age at admission he was 4.6 years (SD 2.4). In seven studies, initiation of diet was delayed until an average age of 4 years or older.
According to the researchers, the average age at onset of seizures was 1.4 years (SD 1.6), the mean seizure frequency was 27.1 per day (SD 31.8), and the average seizure frequency was 27.1 per day (SD 31.8), probably due to different types of seizures, ranging from 4 to 4 per day. It was in the range of 59.5 times.
As previously mentioned, a 50% or greater reduction in short-term seizures was achieved with all three interventions compared to usual care.
- LGIT: OR 24.7 (95% CI 5.3-115.4)
- Modified Atkins: OR 11.3 (95% CI 5.1-25.1)
- Ketogenic: OR 8.6 (95% CI 3.7-20.0)
Limitations, the team said, included intra-study bias due to the open-label nature of most trials, “clinical heterogeneity” of the patients involved, and “due to different dietary interventions and medium- to long-term outcomes.”
They added, “Future head-to-head comparative studies are needed to further confirm these findings.”
Bansal and co-authors report no conflicts of interest.
Reference source: Devi N, et al “Effectiveness and safety of dietary therapy in childhood drug-resistant epilepsy: A systematic review and network meta-analysis” JAMA Pediatr 2023; DOI: 10.1001/jamapediatrics.2022.5648.