Article

Efficacy and tolerability of the Modified Atkins Diet in adults with pharmacoresistant epilepsy: A prospective observational study

Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
Epilepsia (Impact Factor: 4.57). 04/2011; 52(4):775-80. DOI: 10.1111/j.1528-1167.2010.02941.x
Source: PubMed

ABSTRACT

Evidence from the pediatric population exists for the efficacy of ketogenic diets in reducing seizure frequency in patients with intractable epilepsy. Recent evidence suggests that a Modified Atkins Diet may be a beneficial form of cotherapy for adult patients with pharmacoresistant epilepsy.
A prospective, open-label study was performed of adults > 18 years of age with pharmacoresistant epilepsy. Carbohydrates were restricted to 20 g/day. Fluids and calories from protein and fat were allowed ad libitum.
  Eighteen patients, ages 18-55 years, were initially enrolled. Using an intent-to-treat analysis, 12% had a >50% seizure reduction after 3 months; 28% after 6 months, and 21% after 12 months. Response at 3 months predicted response at 12 months in 79% of patients. The mean decrease in weight was 10.9 kg and the mean decrease in body mass index (BMI) was 3.8, p = 0.01. Fourteen of 18 patients (78%) completed 12 months of this diet. Patients experienced a decrease in triglycerides from (mean) 1.22 to 0.9 mm (p = 0.02).
The Modified Atkins Diet demonstrates modest efficacy as cotherapy for some adults with pharmacoresistant epilepsy and may be also helpful for weight loss. Financial and logistical barriers were significant factors for those who declined enrollment and for those who discontinued the study.

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    • "In addition to showing high levels of efficacy, similar to many AEDs, the dietary interventions are generally quite tolerable, can have associated positive effects such as weight loss,80 and demonstrate effectiveness in a relatively short time period. Whilst AEDs may take several weeks to be titrated up to a therapeutic dose and VNS may take months or years to show an optimal effect,81 the effects of a ketogenic diet can be seen within a few days. "
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    ABSTRACT: It is currently estimated that about 20%-30% of adults and 10%-40% of children diagnosed with epilepsy suffer from uncontrolled or poorly controlled seizures, despite optimal medical management. In addition to its huge economic costs, treatment-refractory epilepsy has a widespread impact on patients' health-related quality of life. The present paper focuses on the concepts of refractory and difficult-to-treat seizures and their pharmacological management. Evidence on efficacy and tolerability of rational pharmacotherapy with antiepileptic drug combinations and of non-pharmacological treatment options such as epilepsy surgery, neurostimulation, metabolic treatment and herbal remedies is reviewed. The importance of early identification of the underlying etiology of the specific epilepsy syndrome is emphasized, to inform early prognosis and therapeutic strategies.
    Preview · Article · Jun 2012
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    • "In that study, 47% had >50% reduction in seizure frequency at 1 month and 33% at 3 months. Side effects reported during e-mail MAD administration were also similar to those reported in prior studies and no serious or irreversible side effects were reported (Carrette et al., 2008; Kossoff et al., 2008a; Smith et al., 2011). One significant side effect that was noted at the conclusion of the study was an increase in total as well as LDL cholesterol. "
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    ABSTRACT: The modified Atkins Diet (MAD) is an effective dietary treatment for children with epilepsy. However, adults may have limited access to this therapy because of lack of availability of dietitian or nutrition support or familiarity with the diet by their treating neurologist. This study was designed to investigate the tolerability and efficacy of the MAD administered solely via e-mail to adults with pharmacoresistant epilepsy. A prospective, open-label, proof-of-principle 3-month study design was employed. Adults were enrolled, instructed on how to self-administer a 20 g carbohydrate per day MAD, and followed by the investigators only via e-mail. There were no clinic visits or dietitian contacts during the study period. Twenty-five participants (median age 30 years [range 18-66 years], 68% female) consented and 22 started the MAD. The median prior anticonvulsants was 5 (range 2-10) and seizure frequency was 5 per week (range 1-140). Urinary ketosis was achieved in 21 participants (95%), of which 16 (76%) reported at least 40 mg/dl (moderate). Twenty-one participants (95%) remained on the MAD at 1 month and 14 (64%) at 3 months. After 1 month, 9 (41%) had >50% seizure reduction including one (5%) with >90% seizure reduction using intent-to-treat analysis. After 3 months, 6 (27%) had >50% seizure reduction including 3 (14%) with >90% seizure reduction. The mean ketogenic ratio was 1.1:1 (fat:carbohydrates and protein) for those who provided a MAD food record at follow-up. Over the study period, the median number of e-mails sent by the participants was 6 (range 1-19). The most frequent side effect was weight loss. E-mail administration of the MAD to adults with refractory epilepsy appears to be feasible and effective. Therefore, when dietitian or physician support is limited for adult patients with epilepsy, remote access via telemedicine could provide an alternative.
    Full-text · Article · Feb 2012 · Epilepsia
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    ABSTRACT: OPINION STATEMENT: In the past 20 years, many antiepileptic drugs (AEDs) have been marketed that are not significantly metabolized by the liver, but some patients still require the use of older and more metabolically complex AEDs for optimal seizure control, and current economic and insurance-coverage limitations have forced many patients to switch to less expensive agents, which are often the older AEDs. For the patient with hepatic disease, it is clearly preferable to use medications with little potential to exacerbate their condition. In my practice, I try to use agents with simpler metabolism, especially for patients with multiple medical problems. Doing this can mean using AEDs in monotherapy that are FDA-approved only for adjunctive use. I also find that older agents and hepatically metabolized AEDs can be the most appropriate for particular patients. Selection of the optimal seizure medication requires consideration of multiple factors, only one of which is the impact on liver function. I routinely obtain an executive laboratory panel at least yearly for even the healthiest of patients, to reassure both the patient and myself that the metabolism of their AED regimen is not significantly affected. Occasionally, a change or abnormality in liver function is identified. Certainly hepatic disease can make epilepsy management more difficult, and communication between the neurologist and the other treating physicians is a necessity, although the neurologist and the hepatologist may have differing opinions on how to respond to worsening liver function. Concern about potential liver damage by AEDs may prompt unnecessary discontinuation, sometimes with disastrous consequences for seizure control. Overly complex AED regimens can cause underlying liver problems to worsen. Clinical observation and judgment must complement the data derived from laboratory parameters. Worsening hepatic disease can also result in encephalopathic states that worsen or mimic seizures. The EEG can often be helpful in differentiating these conditions and is crucial in determining appropriate epilepsy therapy.
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