Abstracts

Rationale: The Modified Atkins diet (MAD), a variation of the classic Ketogenic diet (KD), has been reported to have similar effectiveness, better tolerability as a classic KD. But, many clinicians dithered between the classic KD and the MAD because of the efficacy in most cases. We aimed in this randomized controlled trial study to compare the efficacy on seizure frequency, side effects and tolerability between the classic KD and MAD. In these report, 70 children aged between 1 to 18 years from 2011 to 2013, randomly assigned to KD and AD group. And we compared seizure outcomes, complications, compliances. Methods: Among children who visited to the epilepsy center of the pediatric neurology department of Severance children's hospital from March 2011 to March 2013, children with medically intractable seizures were eligible for enrolment. Enrollment criteria includes 1 year to 18 year old patients with medically intractable seizures. Exclusion criteria include patients with previous experiences of dietary therapy, history of hyperlipidemia, renal stones and any other conditions not enough to overcome dietary therapy. All enrolled patients in both groups were scheduled to follow up visit on 1^st, 3^rd, 6^th month after discharge. On every visit, the seizure frequency was recorded compared to baseline seizure frequency before dietary therapy. Scheduled examinations were done on each visit. Results: We have 108 patients for eligibility. 38 patients refused to participate and 70 subjects were enrolled and randomly assigned to each diet group. The baseline characteristics at enrolment are shown in table 1. 62 of 70 patients (88.5%) were generalized epilepsy and 8 of 70 (11.4%) patients have partial onset seizures. The mean age of patients at the beginning of the dietary therapy was 5.5 years old in KD group and 4.9 years old in AD group. Table2 demonstrate etiologies and specific epilepsy syndromes in both groups. As regards frequency of seizures 3 months after diet, 18 patients from KD group (51.4%), 19 patients from AD (54.2%) showed more than 50% seizure frequency reduction. (table 3) Out of these responder groups (more than 50% reduction of seizure frequencies), 15 patients from KD, 18 patients from AD showed more than 90% seizure reduction effect. At 6 months follow up, 18 patients from KD group, 13 patients AD group remained more than 50% seizure reduction status. And 14 patients of KD group (40%), 13 patients of AD group (42.8%) showed more than 90% seizure reduction. For 12 months, 7 patients in KD group (20%), 3 patients in AD group (8.5%) discontinued because of intolerance. In contrast 7 (20%) in KD group and 8 (22.8%) in AD group patients withdrew from dietary treatment because of ineffectiveness. Conclusions: In summary, AD is as effective as KD in respect of seizure outcome, and less side effects. This is a preliminary data, we need further study and data.