Cervenka M, Henry B, Felton EA, Patton K, Kossoff E. Epilepsy & Behavior 56(2016)32–37.

Purpose

Earlier this month we shared this article in our Keto News. Since we frequently receive questions about dietary therapy in adults, we are sharing open access to this article through our partnership with Epilepsy & Behavior. This paper reports on the experience of an adult epilepsy diet center (AEDC) and demonstrated the feasibility, efficacy, and safety of dietary treatment of adults with epilepsy.

Description of Study

  • This study collected data about adults with epilepsy who were evaluated and treated at an adult diet center from 2010 to 2015.
  • 168 patients were enrolled in the study. Of these, 21% were already on diet when first seen at the AEDC, and 79% were trying dietary therapy for the first time.
  • Most patients were treated with the modified Atkins diet (MAD).
  • Effectiveness of the diet was measured by counting “responders” (people who had a 50% or greater decrease in seizures) and those who became seizure-free during dietary treatment.
  • Safety was determined by following laboratory studies, including measures of blood lipids, blood counts, vitamin D levels, and others.
  • Patients were seen 3 months and 6 months after starting the study and then yearly.

Summary of Study Findings

  • Data were evaluated separately for those already on the diet at the time of the first visit and those who were started on the diet at the first visit.
  • 35 patients were already on diet at first visit:
    • 22% had greater than 50% reduction in seizures during the study.
    • 44% patients were seizure-free at the time of their first visit and stayed seizure free.
    • 3 other people (11%) became seizure-free during the study.
    • 8 stopped the diet for a variety of reasons
  • 101 of 133 patients who had not been treated with the diet started treatment with MAD.
    • 44% remained on the diet throughout the study period.
    • Of those on the diet throughout the study period, 17% had greater than 50% reduction in seizures, and 22% became seizure-free.
    • Over half (56%) stopped the diet or were lost to follow up. Reasons for coming off the diet included diet restrictions, not enough benefit, and side effects.
  • A little more than 1 out of 3 people (39%) reported side effects from dietary therapy:
    • Weight lost (19%)
    • Abnormal blood lipids (39%)
    • Gastrointestinal (stomach) complaints (6%)
    • Kidney stones (2 patients)
    • Osteopenia / osteoporosis (thinning of the bones) (2 patients).

What does this mean?

  • Dietary treatment with MAD is a reasonable option for adults as well as children with poorly controlled epilepsy.
  • Of patients who remained on the diet for the study period, about 1 out of 4 adults became seizure-free and 17% had at least a 50% decrease in their seizure frequency.
  • MAD is well tolerated with rare serious side effects. However, the diet restrictions led to many people choosing to stop the diet treatment.
  • This is not a controlled clinical trial, which means a control group was not used and results could not be compared to people who did not use the diet.
  • More studies are needed to prove that the positive effects seen were not due to placebo effect. The study does, however, provide insight into safety and tolerance of diet therapy for adults.

Article published in Epilepsy & Behavior, May 2016.

Authored By: 
Paul M. Levisohn MD | Member | Epilepsy Foundation Professional Advisory Board
Authored Date: 
05/2016
Reviewed By: 
Nathan B. Fountain MD
on: 
Tuesday, May 31, 2016