A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy.
OBJECTIVE
The Atkins diet may induce ketosis as does the ketogenic diet, without restrictions on calories, fluids, protein, or need for an inpatient fast and admission. Our objective was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy.


METHODS
Twenty children were treated prospectively in a hospital-based ambulatory clinic from September 2003 to May 2005. Children aged 3-18 years, with at least three seizures per week, who had been treated with at least two anticonvulsants, were enrolled and received the diet over a 6-month period. Carbohydrates were initially limited to 10 g/day, and fats were encouraged. Parents measured urinary ketones semiweekly and recorded seizures daily. All children received vitamin and calcium supplementation.


RESULTS
In all children, at least moderate urinary ketosis developed within 4 days (mean, 1.9). Sixteen (80%) completed the 6-month study; 14 chose to remain on the diet afterward. At 6 months, 13 (65%) had >50% improvement, and seven (35%) had >90% improvement (four were seizure free). Mean seizure frequency after 6 months was 40 per week (p = 0.005). Over a 6-month period, mean serum blood urea nitrogen increased from 12 to 17 mg/dl (p = 0.01); creatinine was unchanged. Cholesterol increased from 192 to 221 mg/dl, (p = 0.06). Weight did not change significantly (34.0-33.7 kg); only six children lost weight. A stable body mass index over time correlated with >90% improvement (p = 0.004).


CONCLUSIONS
A modified Atkins diet is an effective and well-tolerated therapy for intractable pediatric epilepsy.
Kossoff
Eric H
EH
John M. Freeman Pediatric Epilepsy Center, Departments of Neurology and Pediatrics, the Johns Hopkins Medical Institutions, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MS 21287-1000, U.S.A. ekossoff@jhmi.edu
McGrogan
Jane R
JR
Bluml
Renee M
RM
Pillas
Diana J
DJ
Rubenstein
James E
JE
Vining
Eileen P
EP
D000293:Adolescent; D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D001806:Blood Urea Nitrogen; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D050528:Diet, Carbohydrate-Restricted / Q000379:methods*; D004041:Dietary Fats / Q000008:administration & dosage / Q000378:metabolism; D004044:Dietary Proteins / Q000008:administration & dosage / Q000378:metabolism; D004827:Epilepsy / Q000097:blood / Q000178:diet therapy* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007659:Ketones / Q000652:urine; D007662:Ketosis / Q000097:blood / Q000209:etiology / Q000652:urine; D008297:Male; D009584:Nitrogen / Q000097:blood; D016896:Treatment Outcome; D015431:Weight Loss
D000927:Anticonvulsants; D004041:Dietary Fats; D004044:Dietary Proteins; D007659:Ketones; D002784:Cholesterol; D003404:Creatinine; D009584:Nitrogen