Modified Atkins Diet versus low glycemic index treatment in children with drug-resistant epilepsy: A systematic review and meta-analysis

Introduction

Both the Modified Atkins Diet (MAD) and Low Glycemic Index Treatment(LGIT) are considered less restrictive than the ketogenic diet and effective in children with drug-resistant epilepsy(DRE). Several randomized controlled trials (RCTs) have compared these two diets.

Methods

All RCTs directly comparing MAD and LGIT for DRE were included in the review. We pooled estimates for percentage seizure frequency reduction, the number of participants with seizure freedom, ≥90 % and ≥50 % reduction in seizure frequency, as well as changes in cognition, behavior, and adverse effects in both groups.

Results

Three RCTs with 265 participants were included. The pooled estimates for the number of children achieving seizure freedom, ≥50 %, and ≥90 % reduction in seizure frequency post-intervention, as well as weekly percentage seizure frequency reduction, were comparable between the MAD and LGIT groups(RR: 1.24 [95 % CI: 0.71–2.16]; I²=0 %, p = 0.45, RR: 0.86 [95 % CI: 0.57–1.29]; I²=62 %, p = 0.45, RR: 1.35 [95 % CI: 0.82–2.21]; I²=5 %, p = 0.24, and MD:6.5 [95 % CI:13.8 to 0.6]; I²=45 %, p = 0.07). The number of children showing improvement in cognition and changes in behavioral comorbidities were also comparable between the groups(p = 0.60 and 0.21). However, the MAD group had a higher incidence of adverse effects(RR: 1.37 [95 % CI: 1.12–1.68]; I²=42 %, p = 0.002), though the number of participants experiencing serious adverse effects was similar in both groups(RR: 1.68 [95 % CI: 0.71–3.99]; I²=0 %, p = 0.24). Adherence rates to the allocated intervention were numerically higher in the LGIT group(p = 0.73).

Conclusion

Both MAD and LGIT are comparable in efficacy, but LGIT is associated with fewer adverse effects.