WASHINGTON -- Posters on the ketogenic diet were in abundance at the 2017 American Epilepsy Society meeting, and many focused on how to boost compliance, given that the diet is known for its restrictiveness. Here's a selection of posters examining those strategies for both kids and adults with epilepsy.
Modified Atkins in Kids
The modified Atkins diet may be a in pediatric patients with refractory epilepsy, according to Eu Gene Park, MD, of Samsung Medical Center in Seoul, South Korea, and colleagues.
Action Points
- Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The ketogenic diet has been gaining popularity as a treatment for drug-resistant epilepsy, but some say the diet is too restrictive, making compliance a challenge. The modified Atkins diet is a less restrictive form of the ketogenic diet that may be useful as an alternative, the researchers said.
They conducted a retrospective chart review of 26 pediatric patients treated with the modified Atkins diet at Samsung Medical Center from January 2011 to March 2017. The mean age at initiation was 11 years, and the diet was continued for a mean duration of 5.9 months.
After 6 months of therapy, 38.5% of patients remained on the diet, with 60% having a more than 50% reduction in seizures and 20% becoming seizure-free. Those who had stayed on the diet at least 3 months had a mean reduction in BMI, falling from 22.6 to 20.9.
There were few side effects, but these included constipation and elevated lipids. Still, the researchers concluded the modified Atkins diet may serve as alternative treatment for children with refractory epilepsy who can't tolerate the ketogenic diet because of its restrictiveness or adverse effects.
A Slow Approach to Keto
A slower implementation of the ketogenic diet than jumping right into the full diet, according to Rajesh RamachandranNair, MBBS, of McMaster Children's Hospital in Hamilton, Ontario in Canada.
Typically in Canada, the ketogenic diet -- with a 4:1 fat-to-carbohydrate ratio -- is initiated on an inpatient basis for careful monitoring of metabolic changes. Instead, RamachandranNair's group investigated the effects of starting the diet at a ratio of 0.67:1 or 1:1.
Using a combination of retrospective chart review and prospective study, they enrolled 40 children, median age 4 years, who had tried and failed at least two anti-epileptic drugs (AEDs) and began the ketogenic diet at home using the lower ratios.
If seizures were controlled and the diet tolerated, the ratio remained unchanged. If seizures weren't controlled, the ratio of fats-to-carbohydrates was increased gradually every 2-3 weeks.
On average, they found that patients settled on a ratio of 1.5:1 or 2:1, and seizure reduction followed: seizure frequency fell from an average of 90 per month before the diet to 24 per month a half-year later. At that time, 58% of kids had at least a 50% reduction in seizures, 23% had at least a 90% reduction in seizures, and 15% were seizure-free.
Eight patients discontinued the diet before 6 months, either because their seizures weren't controlled or they couldn't tolerate the diet.
The researchers concluded that slow outpatient titration of the classic ketogenic diet may help patients achieve good seizure control.
Ketogenic Drink May Boost Compliance
Adding a high-fat drink to the modified Atkins diet in adults with drug-resistant epilepsy, according to Mackenzie Cervenka, MD, of Johns Hopkins in Baltimore, and colleagues.
Compliance with the ketogenic diet is often poor in adults: about half quit the diet within 6 months, the researchers said. To improve compliance, they used the modified Atkins, and investigated whether adding KetoCal, a 4:1 fat-to-carbohydrate drink, could offer additional help for keeping patients on the diet.
They enrolled 80 adults with drug-resistant epilepsy who had at least four seizures per month, and randomized them to KetoCal in combination with modified Atkins during the first month (the treatment group) or adding the drink to the diet during the second month (the control group).
Overall, there were no differences between groups in terms of seizure frequency, in the proportion of patients achieving at least a 50% response, or in mean seizure reduction from baseline at 1, 2, or 6 months, and there was an overall reduction in seizures in all patients in the study.
However, significantly more patients who got the drink in the first month remained on the modified Atkins diet at last follow-up, a mean of 11 months for controls and 13 months for treated patients (43.3% versus 17.2%, P=0.047), suggesting that KetoCal may help improve compliance.
Disclosures
The study by RamachandranNair's group was funded by the Ontario Brain Institute.
The study by Cervenka's group was funded by Nutricia North America.
Primary Source
American Epilepsy Society
Park EG, et al "A modified Atkins diet for intractable pediatric epilepsy" AES 2017; Abstract 2.193.
Secondary Source
American Epilepsy Society
RamachandranNair R, et al "Good seizure control can be achieved at low ratios by slow outpatient titration of the ketogenic diet" AES 2017; Abstract 3.332.
Additional Source
American Epilepsy Society
Cervenka M, et al "Improving compliance in adults with drug-resistant epilepsy on a modified Atkins diet: Results from a randomized, controlled trial" AES 2017; Abstract 3.339.