Modified Atkins diet for drug-resistant epilepsy: A systematic review and meta-analysis of randomized controlled trials.

Abstract

To evaluate the effectiveness and side-effect profile of the modified Atkins diet (MAD) compared to the usual diet (UD) in reducing seizure frequency among patients with drug-resistant epilepsy (DRE). In February 2023, we conducted an extensive search in PubMed, EMBASE, and Cochrane databases to find randomized controlled trials (RCTs) comparing MAD to UD in patients with drug-resistant epilepsy (DRE) on standard anti-seizure medication (ASM). We used random-effects meta-analyses and the Risk of Bias 2 tool to evaluate treatment effects and assess the quality of the included RCTs, respectively. Six studies were evaluated in the meta-analysis, including 575 patients, of whom 288 (50.1%) were randomized to the MAD. Average follow-up period was 12 weeks. MAD plus standard drug therapy was associated with a higher rate of 50% or greater reduction in seizure frequency compared to UD plus drug therapy (RR 6.28; 95% CI 3.52-10.50; p<0.001), both in children (RR 6.28; 95% CI 3.43-11.49; p<0.001) and adults with DRE (RR 6.14; 95% CI 1.15-32.66; p=0.033). MAD was also associated with a higher seizure freedom rate compared to UD (RR 5.94; 95% CI 1.93-18.31; p=0.002). Five studies reported adverse events with MAD; constipation was reported in 17% of patients (95% CI 5-44%), lethargy in 11% (95% CI 4-25%), and anorexia in 12% (95% CI 8-19%). Due to limited information about the ASM regimens, we were unable to further analyze the interaction between MAD and ASM. This meta-analysis, comprising 575 patients from 6 RCTs, revealed that MAD led to higher rates of seizure freedom and underscored its role in seizure frequency reduction by 50% or more in both adults and children, with no significant adverse events concerns.