Modified Atkins diet versus ketogenic diet in children with drug-resistant epilepsy: A meta-analysis of comparative studies.

ABSTRACT

INTRODUCTION: The modified Atkins diet (MAD), a less restrictive form of the ketogenic diet (KD), has gained popularity and is proposed to be an alternative to the traditional KD in the management of drug-resistant epilepsy (DRE). However, the evidence to support this hypothesis remains limited. In this meta-analysis, we aimed to evaluate the efficacy and tolerability of MAD compared to traditional KD in children with DRE. METHOD: We systematically searched multiple databases through March 2022 for all the studies that evaluated the clinical utility of MAD versus KD for DRE in a pediatric population. The primary outcome was the proportion of children who had seizure frequency reduction (SFR) > 50%. The secondary outcomes were SFR >90%, seizure freedom, and diet-related side effects. All measurements were taken 6 months after starting the regimens. Pooled risk ratio (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using random-effects model meta-analysis. RESULTS: Six studies, with 397 patients with DRE (201 followed MAD vs. 196 with KD), were included. There was a significant difference in the proportion of patients who attained SFR >50% favoring the traditional KD (RR 0.63; 95% CI 0.47-0.83; P = 0.001). However, there was no significant differences in SFR >90% (RR 0.73; 95% CI 0.49-1.10; P = 0.13) or the proportion of patients who had seizure freedom (RR 0.83; 95% CI 0.49-1.41; P = 0.49). Furthermore, both regimens had comparable safety profiles (RR 1.00; 95% CI 0.95-1.05; P = 0.96). CONCLUSIONS: Our meta-analysis demonstrated the superiority of traditional KD over MAD in achieving SFR > 50% at 6 months in pediatric patients with DRE. However, SFR > 90% and seizure freedom were comparable between KD and MAD at 6 months. The tolerability profile between the two regimens was similar as well. Large-scale RCTs are necessary to validate our findings.