title: Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy.
abstract: OBJECTIVE
  We aimed to compare the efficacy, safety, and tolerability of a modified Atkins diet (MAD) with the classic ketogenic diet (KD) for the treatment of intractable childhood epilepsy.
  
  
  METHODS
  From March 2011 to March 2014, 104 patients aged 1-18 years who had refractory epilepsy were randomly assigned to each diet group (ClinicalTrials.gov, number NCT2100501). A seizure diary record was used to compare seizure frequencies with the baseline prediet seizure frequency at the third and sixth months after diet therapy initiation.
  
  
  RESULTS
  Fifty-one patients were assigned to the KD and 53 patients to the MAD. The KD group had a lower mean percentage of baseline seizures compared with the MAD group at 3 months (38.6% for KD, 47.9% for MAD) and 6 months (33.8% for KD, 44.6% for MAD), but the differences were not statistically significant (95% confidence interval [CI] 24.1-50.8, p = 0.291 for 3 months; 95% CI 17.8-46.1, p = 0.255 for 6 months). Instead, for patients aged 1-2 years, seizure outcomes were consistently much more favorable in patients consuming the KD compared with those consuming the MAD. The rate of seizure freedom at 3 months after diet therapy initiation was significantly higher (53% for KD, 20% for MAD, p = 0.047) in these patients. The MAD had advantages with respect to better tolerability and fewer serious side effects.
  
  
  CONCLUSIONS
  The MAD might be considered as the primary choice for the treatment of intractable epilepsy in children, but the classic KD is more suitable as the first line of diet therapy in patients <2 years of age.
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jeong A
authors.initials: JA
authors.lastname: Kim
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung-Rim
authors.initials: JR
authors.lastname: Yoon
authors.affiliation: Division of Dietetics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Joon Soo
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jeong Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Heung Dong
authors.initials: HD
authors.lastname: Kim
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hoon-Chul
authors.initials: HC
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D050528:Diet, Carbohydrate-Restricted / Q000379:methods*; D055423:Diet, Ketogenic / Q000379:methods*; D004311:Double-Blind Method; D000069279:Drug Resistant Epilepsy / Q000097:blood / Q000178:diet therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007657:Ketone Bodies / Q000097:blood; D008297:Male; D016896:Treatment Outcome
chemical_list: D007657:Ketone Bodies