Abstracts

Rationale: This study investigated factors associated with improved seizure control in adults with epilepsy following a modified Atkins diet (MAD). No studies in adults with epilepsy have evaluated whether changes in lipid biomarkers observed following MAD initiation are directly related to seizure efficacy. Given the well documented lipid changes that occur with short-term MAD use, this study aimed to evaluate the relationship between lipid biomarkers and seizure reduction in adults treated with the MAD for 3 months.


Methods: Participants enrolled in an ongoing prospective study were retrospectively evaluated. Participants followed a 20 gram/day net carbohydrate limit MAD. Collected baseline demographic measures included age at study and diet onset, gender, self-identified ethnicity, number of prior and current anti-seizure medications (ASMs) used, ASMs at study enrollment, smoking history, personal history of diabetes, hypertension, cardiovascular disease, myocardial infarction, stroke, and dyslipidemia, physical exercise levels, and family history of myocardial infarction and stroke. Anthropometric (weight and body mass index) and serologic measures were collected at baseline and 3 months. Serum levels of total cholesterol, triglycerides, high and low density lipoprotein cholesterol (LDL), apolipoproteins B and A1, LDL particle number, LDL sub-class, and LDL peak size were measured.


Results: The total cohort included 33 adults with epilepsy of mean age 37 years (range 18 – 66) and 58% women. The majority 25/33 (76%) had focal epilepsy. There were 16 (48%) participants who experienced a reduction in seizure frequency ≥ 50%, classified as responders, and 17 (52%) participants who experienced a reduction < 50%, classified as non-responders. Additionally, 8 (24%) participants in the cohort experienced a reduction in seizures ≥ 90%. Demographic and clinical differences between diet responders and non-responders were evaluated. No significant differences were found for gender, age at diet initiation, or age at epilepsy diagnosis. However, a notable relationship emerged between epilepsy type and diet response (p = 0.011) with a clinical response of 88% seen in adults with generalized epilepsy and a response of only 36% in adults with focal epilepsy. There were no significant correlations for number of current or past medications tried. Those who responded to the diet trended towards higher serum lipid levels with higher absolute mean increases in almost every lipid biomarker measured. However, only Apolipoprotein-B and remnant cholesterol exhibited statistically significant increases from baseline in responders compared to non-responders (p = 0.022 and 0.043, respectively).


Conclusions: These findings support the continued use of MAD particularly for seizure management in adults with generalized epilepsy and highlight potential mechanisms of clinical response involving lipoprotein and energy metabolism.


Funding: The Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, the Johns Hopkins KL2 Mentored Career Development Award, and a grant from the American Epilepsy Society.