Comparison of seizure reduction and serum fatty acid levels after receiving the ketogenic and modified Atkins diet (original) (raw)

Approximately 30% of patients with epilepsy have refractory epilepsy, i.e. seizures persist despite accurate diagnosis and carefully monitored treatment with antiepileptic (AEDs) drugs. 1,2 The ketogenic diet (KD) is a high-fat, adequate-protein and very low-carbohydrate diet that has been used for many years to treat intractable epilepsy in children. The KD has been shown to be effective in retrospective, prospective and randomized controlled studies. 3-6 In a randomized controlled trial, after 3 months of the KD, 38% of patients had >50% seizure reduction compared with 6% of the controls, while 7% of patients had >90% seizure reduction compared with none of the controls. 5 In Korean and American multicentric studies, more than 40-50% of patients had a >50% reduction in seizure frequency after 6 and 12 months. 6,7 More recently, the modified Atkins diet has been used to treat intractable epilepsy. 8-13 The modified Atkins diet induces ketosis without fluid, calorie or protein restriction, nor the requirement for fasting or food weighting. Daily carbohydrates are limited and high-fat intake encouraged. The modified Atkins diet was designed to be a less restrictive alternative than the KD. Early studies have suggested efficacy and safety in both children and adults. 8-13 The mechanisms by which the KD and modified Atkins diet exert their anti-seizure effects are not clear. Among the possible mechanisms of action, it has been hypothesized that various fatty acids, by influencing neuronal excitability, may constitute part of beneficial effects of KD on seizure control. 14-21 In a study of 9 children on KD, elevated blood polyunsaturated fatty acid (PUFA) was found. The rise in arachidonic acid (AA) was correlated with seizure control. 22 However, a decrease in serum AA and an increase of linoleic (LA) and eicosapentaenoic (EPA) acids were found in another study including 25 patients. 23 In the latter, no correlation between serum fatty acids levels and seizure control was found. We report our experience using both classic KD and modified Atkins diet in children with refractory epilepsy. Our aim was to compare the relative efficacy of the diets and to evaluate serum long chain fatty acids profiles.