Review Article

The Modified Atkins Diet in Refractory Epilepsy

Table 1

Summary of studies involving children treated with MAD.

Authors Study type Sample size Age range EpilepsyAt 3 monthsAdverse effects
>50%>90%

Kossoff et al. 2003 [12]Open trial67–52 yrsMixed3Not reported
Kossoff et al. 2006 [13]Prospective203–18 yrs≥3 Sz/week on at least 2 AEDs50%11%Constipation
Kossoff et al. 2007 [18]Randomized cross-over (10 g versus 20 g)203–18 yrsAt least daily countable seizures10 g—60%
20 g—10%
10 g—30%
20 g—0%
Improved tolerability with 20 g
Kang et al. 2007 [14]Prospective14Mean 7.4 yrs≥4 Sz/month; ≥3 AEDs50%29%Gastrointestinal disturbances
Porta et al. 2009 [19]Retrospective274–182 months≥2 Sz/week,
≥3 AEDs
KD—64%
MAD—20%
Mild digestive disorders
Weber et al. 2009 [20]Prospective152–17 yrs≥1 Sz/week,
≥2 AEDs
40%13%Not significant
Tonekaboni et al. 2010 [21]Prospective271–16 yrs≥3 AEDs tried67%25%Minor
Miranda et al. 2010 [22]Prospective331–16 yrsMedically intractable epilepsy52%42%Subtle
Kossoff et al. 2011 [23]Prospective 
(MAD + 1 month Ketocal)
303–18 yrsAt least daily countable seizures;
≥2 AEDs
At 1 month, 80%
At 2 months, 70%
37% 
43%
Constipation
Groomes, et al. 2011 [24]Retrospective + prospective21
(8-ketogenic diet, 13-MAD)
Median age at diet onset—6 yrsIntractable childhood and juvenile absence epilepsy82%38%Not mentioned
Kumada et al. 2012 [25]Prospective101.5–17 yrs≥3 Sz/week,
≥3 AEDs
At 3 weeks, 32
Sharma et al. 2012 [26]Prospective156 m–3 yrsDaily infantile spasms40% spasm freeConstipation
Kim et al. 2012 [27]Retrospective 2021 m–17 yrsMixed55%*35%*Constipation, hypercalciuria, hyperuricemia, transient lipase elevation
Sharma et al. 2013 [28]Randomized controlled trialTotal 102, 50 randomized to diet group2–14 yrsDaily seizures, or at least 7/week52% in diet group versus 11.5% in control group30% in diet group versus 7.7% in control groupConstipation, anorexia, vomiting, lethargy

Efficacy during the recent or final 3 months of the diet therapy.
AEDs: antiepileptic drugs; Sz: seizures; MAD: modified Atkins diet; KD: ketogenic diet.