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

Tanya J W McDonald; Bobbie J Henry-Barron; Elizabeth A Felton; Erie G Gutierrez; Joanne Barnett; Rebecca Fisher; MonYi Lwin; Amanda Jan; Diane Vizthum; Eric H Kossoff; Mackenzie C Cervenka

doi:10.1016/j.seizure.2018.06.019

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.

Authors

Affiliations

¹ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: twill145@jhmi.edu.
² Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, United States. Electronic address: bjhenry@jhu.edu.
³ Department of Neurology, University of Wisconsin, Madison, WI, United States. Electronic address: felton@neurology.wisc.edu.
⁴ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: egonz24@jhmi.edu.
⁵ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: jbarne14@jhmi.edu.
⁶ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: rfisher2@jhmi.edu.
⁷ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: mlwin3@jhu.edu.
⁸ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: amanda@thejans.net.
⁹ Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, United States. Electronic address: dblahut1@jhmi.edu.
¹⁰ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: ekossoff@jhmi.edu.
¹¹ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: mcerven1@jhmi.edu.

PMID: 29960852
DOI: 10.1016/j.seizure.2018.06.019

Abstract

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