Use of a modified atkins diet in intractable childhood epilepsy

Purpose: To evaluate the efficacy, safety and tolerability of a modified Atkins diet in intractable childhood epilepsy. Methods: Fourteen children with epilepsy were treated prospectively with a modified Atkins diet. Outcome measures included seizure frequency, adverse reactions and tolerability to the diet; blood beta-hydroxybutyrate and urine ketones were also measured. Results: Six months after diet initiation, seven (50%) remained on the diet, five (36%) had > 50% seizure reduction, and three (21%) were seizure free. The diet was well tolerated by 12 (86%) patients. Most complications were transient and were successfully managed by careful follow-up and conservative strategies. A consistently strong ketosis (beta-hydroxybutyrate of > 3 mmol/L) seemed to be important for maintaining the efficacy of the diet therapy. Conclusions: The modified Atkins diet was well tolerated and sometimes a modified Atkins diet can be substituted for the conventional ketogenic diet. Serious complications were rare, but long-term complications remain to be determined.