Summary:Purpose: To evaluate the efficacy, safety and tolerability of a modified Atkins diet in intractable childhood epilepsy.Methods: Fourteen children with epilepsy were treated prospectively with a modified Atkins diet. Outcome measures included seizure frequency, adverse reactions and tolerability to the diet; blood β-hydroxybutyrate and urine ketones were also measured.Results: Six months after diet initiation, seven (50%) remained on the diet, five (36%) had >50% seizure reduction, and three (21%) were seizure free. The diet was well tolerated by 12 (86%) patients. Most complications were transient and were successfully managed by careful follow-up and conservative strategies. A consistently strong ketosis (β-hydroxybutyrate of >3 mmol/L) seemed to be important for maintaining the efficacy of the diet therapy.Conclusions: The modified Atkins diet was well tolerated and sometimes a modified Atkins diet can be substituted for the conventional ketogenic diet. Serious complications were rare, but long-term complications remain to be determined. Key Words: Atkins diet-Intractable childhood epilepsy.The ketogenic diet (KD) has been used worldwide for the treatment of intractable childhood epilepsy (Kossoff and McGrogan, 2005). However, the KD is not yet a convenient therapy, especially in older children and adolescents (Freeman et al., 1998;Kang et al., 2004). The Atkins diet induces a state of ketosis by providing a high fat content and few carbohydrates, suggesting that this diet may control seizures by a mechanism similar to that of the KD (Stafstrom, 2004). Recently, a modified Atkins diet was shown to be effective and well tolerated in children with intractable epilepsy (Kossoff et al., 2006). We also aimed in this study to evaluate the efficacy, safety and tolerability of a modified Atkins diet in 14 children with intractable childhood epilepsy. METHODSThe subject cohort consisted of 14 patients with intractable childhood epilepsy who had been experiencing more than four seizures per month, which could not be controlled by any combination of three or more antiepileptic drugs. They were treated prospectively with a modified Atkins diet and were followed for at least more than 6 months since the diet had been tried at a tertiary care referral epilepsy center. The modified Atkins diet consisted of a nearly balanced diet (60% fat, 30% protein, and 10% carbohydrates by weight), without the restriction of recommended daily calories according to patient age, and substituting the initial stepwise caloric increase of the nonfasting protocol for initial fasting and fluid restriction (Fig. 1). As suggested by Kossoff et al. (2006), for the first month, carbohydrates were restricted to 10 g/day, but were permitted to increase by 5 g/day at intervals of at least 1 month if the child was having difficulty with the restriction of carbohydrates, to a maximum of 10% carbohydrates per day by weight. Following the start of the diet, all patients were advised to remain in the hospital for 3 or 4 days to ensure adequate diet ...

We retrospectively reviewed the medical records of 189 children who were admitted to the Pediatric Neurology Department at Yonsei University College of Medicine with status epilepticus (SE) between April, 1994 and April, 2003. The children were followed up for a mean duration of 17 months. We analyzed the clinical findings and the relationships between neurologic sequelae, recurrence, age of onset, presumptive causes, types of seizure, seizure duration and the presence of fever. Mean age at SE onset was 37 months. Incidences by seizure type classification were generalized convulsive SE in 73.5%, and non-convulsive SE in 26.5%. The incidences of presumptive causes of SE were idiopathic 40.7%, epilepsy 29.1%, remote 16.4% and acute symptomatic in 13.3%. Among all the patients, febrile episodes occurred in 35.4%, especially in patients under 3 year old, and 38.4% of these were associated with febrile illness regardless of presumptive cause. Neurologic sequelae occurred in 33% and the mortality rate was 3%. Neurologic sequelae were lower in patients that presented with an idiopathic etiology and higher in generalized convulsive SE patients. The recurrence of SE was higher in patients with a remote symptomatic epileptic etiology, and generalized convulsive SE showed higher rates of recurrence. Based on this retrospective study, the neurologic outcomes and recurrence of SE were found to be strongly associated with etiology and seizure type. Age, seizure duration and the presence of febrile illness were found to have no effect on outcome.

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