The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial

Poorshiri, Bita; Barzegar, Mohammad; Tahmasebi, Sanaz; Shiva, Shadi; Raeisi, Sina; Ebadi, Zakiyeh

doi:10.1007/s13760-019-01225-0

Cited by 36 publications

(30 citation statements)

References 19 publications

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“…A metaanalysis showed no difference in the efficacy of classical KD and MAD in children and adolescents with intractable epilepsy. 2 Poorshiri et al 25 found the efficacies of classical KD and MAD in the treatment of refractory epilepsy to not be significantly different, although MAD was reported to be more favorable in terms of tolerability and the fewer associated side effects.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of ketogenic diet therapy in children diagnosed with drug-resistant epilepsy: a single-center experience

Yıldırım¹,

Yağcı²,

Uygur³

et al. 2022

Turk J Pediatr

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Background. We evaluate here the effect of the ketogenic diet (KD) on children with drug-resistant epilepsy (DRE) in terms of clinical effectiveness, anthropometric measurements, and some electroencephalogram (EEG) and biochemical findings. Methods. Included in the study were 18 children (median age 70 months, 61.1% female) who received the classical KD and modified Atkins diet (MAD) for at least one year due to DRE. The patients` demographic and laboratory data; weight, height and body mass index values; EEG and electrocardiographic findings; abdominal ultrasonography findings; and biochemical parameters were recorded at baseline and at 12 months after the initiation of the diet. A reduction of ≥50% in the number of seizures was accepted as a response to KD. Results. Classic KD was chosen for 14 patients (77.8%), and MAD for four patients (22.2%). The response to KD therapy (≥50% reduction) was 55.5% (n = 10) (p = 0.008), and one patient even became seizure-free. By the 12th month of treatment, 10 patients had experienced a reduction of more than 50% in epileptiform discharges, as indicated by EEG findings. There was no difference in seizure reduction between the patients who received classical KD and MAD. A total of 11.1% of the children lost weight during KD treatment. The most common side effect was constipation (n = 10, 55.6%). At the end of one year of treatment, total cholesterol and low density lipoprotein cholesterol (LDL-C) LDL-C levels had increased dramatically, while fasting blood glucose levels had decreased significantly. Conclusions. Our study suggests that KD treatment provides good clinical efficacy in the treatment of pediatric DRE, and can significantly reduce the frequency of epileptic discharges. Also, total cholesterol and LDL-C levels increased significantly, and fasting blood glucose levels decreased significantly compared to the baseline levels.

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Section: Discussionmentioning

confidence: 99%

Evaluation of ketogenic diet therapy in children diagnosed with drug-resistant epilepsy: a single-center experience

Yıldırım¹,

Yağcı²,

Uygur³

et al. 2022

Turk J Pediatr

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“…48 Due to the low incidence of major side effects, the MAD is recommended for children older than 2 years of age with refractory epilepsy. 50 The panelists acknowledged use of low glycemic index diet, especially in super refractory status and in acute conditions. They stated that KD is effective in myoclonic seizures without metabolic disorder, generalized and absence seizures, and that one-third of the patients have good seizure control.…”

Section: Role Of Ketogenic Dietmentioning

confidence: 99%

A Review of the Prevalence, Etiology, Diagnosis, and Management of Pediatric Epilepsies in India

Kalra

Venkataraman

Shah

2022

Journal of Pediatric Neurology

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Pediatric seizures are one of the most common neurological manifestations seen in pediatrics. Unravelling the etiology, timely and appropriate investigations followed by suitable therapies are essential for improving quality of life. During the pandemic, focused group discussions were conducted among 50 pediatric neurologists across five cities in India to gather insights on treatment practices in pediatric epilepsy and to optimize therapeutic strategies and alternative approaches for rational use of antiepileptic medications. These discussions were mainly aimed at reviewing current literature on prevalence, etiology, diagnosis, and management of epilepsy in children and subsequently rationalizing diagnostic and treatment approaches in routine clinical practice. Epileptic encephalopathies comprise of childhood epilepsy with progressive cerebral dysfunction. Genomics plays a vital role in identifying the underlying genetic associations, empowering precision therapy. Currently, the ketogenic diet has become a well-recognized modality for reducing severity of seizures. To overcome the high incidence of adverse effects due to older antiepileptic drugs, newer drugs are being developed to improve ease of use, diminish drug interactions, decrease adverse effects, and identify drugs with unique mechanisms of action. Common lacunae in practice include information gaps, educating parents, or caregivers about rational drug use and ensuring compliance to antiepileptic medications. This article discussed the consensus clinical viewpoint of expert clinicians, as well as insights on optimized treatment of pediatric epilepsies in both infancy and childhood. It also discusses aspects, like reducing drug burden, emerging therapies in the identification of the genetic basis of epilepsies, and targeted therapy alternatives, for pediatric populations in the Indian scenario.

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“…Consequently, adherence in this age group is much better for MAD than CKD. Due to slower implementation of MAD than CKD, many of the metabolic fluctuations experienced during the initial few weeks of MAD could be avoided [56,57]. When CKD causes too many side-effects or is found to be too restrictive, it could be transformed into MAD resulting in more favorable clinical profile [58].…”

Section: Available Ketogenic Dietsmentioning

confidence: 99%

Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned

Żarnowska

2020

Nutrients

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Ketogenic diet (KD) has been used to treat epilepsy for 100 years. It is a high-fat, low-carbohydrate, and sufficient-protein-for-growth diet that mimics the metabolic changes occurring during starvation. Except for classic KD, its modified counterparts, including modified Atkins diet and low-glycemic-index treatment, have gained grounds to increase palatability and adherence. Strong evidence exists that the KD offers protection against seizures in difficult-to-treat epilepsy and possesses long-lasting anti-epileptic activity, improving long-term disease outcome. The KD can also provide symptomatic and disease-modifying activity in a wide range of neurodegenerative diseases. In an era of highly available new anti-seizure medications (ASMs), the challenge of refractory epilepsy has still not been solved. This metabolic therapy is increasingly considered due to unique mechanisms and turns out to be a powerful tool in the hands of a skillful team. Despite decades of extensive research to explain the mechanism of its efficacy, the precise mechanism of action is to date still largely unknown. The key feature of this successful diet is the fact that energy is derived largely from fat but not from carbohydrates. Consequently, fundamental change occurs regarding the method of energy production that causes alterations in numerous biochemical pathways, thus restoring energetic and metabolic homeostasis of the brain. There are barriers during the use of this special and individualized therapy in many clinical settings worldwide. The aim of this review is to revisit the current state of the art of therapeutic application of KD in refractory epilepsy.

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The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial

Cited by 36 publications

References 19 publications

Evaluation of ketogenic diet therapy in children diagnosed with drug-resistant epilepsy: a single-center experience

Evaluation of ketogenic diet therapy in children diagnosed with drug-resistant epilepsy: a single-center experience

A Review of the Prevalence, Etiology, Diagnosis, and Management of Pediatric Epilepsies in India

Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned

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