Promising Dietary Approach for Drug-Resistant Epilepsy
According to a study published in Neurology – the medical journal of the American Academy of Neurology – a combination of a modified Atkins diet rich in fat and low in carbohydrates along with medication may lower the frequency of seizures in individuals with hard-to-treat epilepsy.
“For people with drug-resistant epilepsy, or those who have been unable to find an effective treatment to reduce seizures, it’s encouraging to see that there are lifestyle changes that can be combined with standard drug therapy to reduce the number of seizures,” said study author Manjari Tripathi, MD, DM, of All India Institute of Medical Sciences in New Delhi. “Our study found that this combination may reduce the chance of seizures by more than half.”
Modified Atkins Diet
The modified Atkins diet blends the Atkins diet and the ketogenic diet, featuring foods such as soy products, heavy cream, oils, butter, leafy green vegetables, and animal protein like eggs, chicken, fish, and bacon. Despite the proven efficacy of the ketogenic diet in reducing seizures, its demanding guidelines and limitations can make it challenging to adhere to. The modified Atkins diet offers a more flexible alternative.
The study involved 160 adults and adolescents who had epilepsy for more than 10 years on average and had at least 27 seizures per month despite trying an average of four antiseizure medications at the maximum tolerated dose. They were randomly assigned to receive either standard drug therapy alone or drugs plus the modified Atkins diet over six months.
Participants logged their seizures and meals. They were given food lists, sample menus, and recipes. Carbohydrate intake was restricted to 20 grams per day. Federal dietary guidelines recommend between 225 and 325 grams of carbs per day.
Significant Reduction in Seizures
After six months, researchers found that 26% of people who had both drug therapy and followed the modified Atkins diet had more than a 50% reduction in seizures compared to only 3% of the people who had drug therapy alone. Four people in the diet group were free of seizures by the end of the study, while no one in the medication-only group was seizure-free.
The study also looked at quality of life, behavior, and side effects at six months. The group that had drug therapy and followed the modified Atkins diet showed an improvement in all areas compared to the group that had drug therapy alone.
Tripathi noted that 33% of the participants did not complete the study due to poor tolerance of the diet, lack of benefits or the inability to follow-up in part due to COVID-19. However, Tripathi said tolerance of the modified Atkins diet was better than what is seen with the ketogenic diet.
“While the modified Atkins diet may be an effective treatment in controlling seizures, further research is needed to identify genetic biomarkers and other factors associated with the response to this diet,” Tripathi added. “This may improve patient care by encouraging targeted precision based earlier use of this diet.”
Reference: “Safety, Efficacy, and Tolerability of Modified Atkins Diet in Persons With Drug-Resistant Epilepsy: A Randomized Controlled Trial” by Mala Manral, Rekha Dwivedi, Sheffali Gulati, Kirandeep Kaur, Ashima Nehra, Ravindra Mohan Pandey, Ashish Datt Upadhyay, Savita Sapra and Manjari Tripathi, 4 January 2023, Neurology.
DOI: 10.1212/WNL.0000000000206776
A limitation of the study is that seizures were self-reported or reported by caregivers, so some seizures may not have been reported.
The study was funded by the Department of Biotechnology, India.
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