Improving compliance in adults with epilepsy on a modified Atkins diet: A randomized trial

Seizure. 2018 Aug;60:132-138. doi: 10.1016/j.seizure.2018.06.019. Epub 2018 Jun 22.


Purpose: To determine whether use of a ketogenic formula during the first month of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE) improves seizure reduction and compliance compared to MAD alone.

Methods: Eighty adults (age ≥18 years) with DRE and ≥4 reliably quantifiable seizures/month were enrolled. All participants were trained to follow a 20 g/day net carbohydrate limit MAD. Patients were randomized to receive one 8-ounce (237 mL) tetrapak of KetoCal®, a 4:1 ketogenic ratio formula, daily in combination with MAD during the first month (treatment arm) or second month (control/cross-over arm). Patients recorded urine ketones, weight, and seizure frequency and followed up at 1 and 2 months.

Results: By 1 month, 84% of patients achieved ketosis (median of 4-4.5 days). At 1 month, the treatment arm had a significantly higher ketogenic ratio and more patients with a ≥1:1 ketogenic ratio compared to the control arm. There was no difference in median seizure frequency, proportion of responders (≥50% seizure reduction), or median seizure reduction from baseline between groups. However, patients treated with KetoCal® during the first month were significantly more likely to continue MAD for 6 months or more.

Conclusion: Although supplementing MAD with a ketogenic formula in the first month did not increase the likelihood of reducing seizures compared to MAD alone, significantly more adults remained on MAD long-term with this approach. This suggests a potential strategy for encouraging compliance with MAD in adults with DRE.

Keywords: Drug-resistant; KetoCal; Ketogenic diet; Ketosis; Seizure.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Body Weight
  • Cross-Over Studies
  • Diet, High-Protein Low-Carbohydrate / adverse effects
  • Diet, High-Protein Low-Carbohydrate / methods*
  • Diet, Ketogenic / adverse effects
  • Diet, Ketogenic / methods
  • Drug Resistant Epilepsy / diet therapy*
  • Drug Resistant Epilepsy / urine
  • Female
  • Follow-Up Studies
  • Humans
  • Ketosis / diet therapy
  • Ketosis / urine
  • Male
  • Patient Compliance*
  • Seizures / diet therapy
  • Seizures / urine
  • Time Factors
  • Treatment Outcome