Use of the Modified Atkins Diet in Intractable Pediatric Epilepsy

BACKGROUND AND PURPOSE: The modified Atkins diet is a less restrictive alternative to the ketogenic diet (KD), allowing unlimited protein, fat, calories, and fluid intake. Moreover, it can be started on an outpatient basis without requiring a fast. This study evaluated the efficacy, tolerability, and compliance of the modified Atkins diet in intractable pediatric epilepsy. METHODS: We retrospectively reviewed the medical records of 26 pediatric patients (10 males and 16 females) with intractable epilepsy who were treated using the modified Atkins diet at Samsung Medical Center from January 2011 to March 2017. RESULTS: The mean age at initiation of the modified Atkins diet was 10.9 (range, 2–21) years. The diet was continued for a mean duration of 5.9 (range, 1–16) months. After 6 months, 10 (38.5%) remained on the diet, of whom six (60%) had > 50% seizure reduction and two (20%) became seizure free. Four of 26 patients (15.4%) reported side effects of the diet, including constipation (n = 2) and lipid profile elevations (n = 2). Mean body mass index (BMI) was reduced from 22.6 to 20.9 kg/m(2) (p < 0.05) in 13 patients who continued the diet for ≥ 3 months. Four of these patients (30.8%) were overweight (BMI > 25 kg/m(2)) before initiating the diet and were satisfied with their BMI changes from a mean of 30.3 to 27 kg/m(2) (p < 0.05). Food refusal (n = 3) and poor parental compliance (n = 3) were the common reasons cited for cessation. CONCLUSIONS: The modified Atkins diet may be an alternative treatment option for children with intractable epilepsy who are unable to tolerate KD because of food intake-related restrictiveness or adverse effects. The continuous support of healthcare professionals and families plays a key role in diet maintenance.