Objective: 

25-30% of patients with epilepsy have uncontrolled seizures. At Ghent University Hospital, a pilot study on the feasibility and efficacy with Atkins' diet has been set up to evaluate its potential as a valuable treatment to control seizures. This ketogenic like diet, was initially set up by Dr. Robert Atkins to lose weight.

Materials and methods: 

To start the trial, the epilepsy patient database was screened for patients with at least 2 seizures a month and without metabolic disorders. Patients were admitted at the neurology department for 48 hours during which the diet is explained and practicalities of the study were taught such as daily checking of urine ketosis and blood level glucose. Patients also underwent 24 hour EEG monitoring, evoked potential examinations, ECG and metabolic check up using blood samples. Results on these tests will be used as baseline information.

During the diet, Every 2 weeks patients are contacted by phone to check for side effects and seizure control. At the epilepsy clinic, patients are seen every month for clinical evaluation, EEG, ECG and metabolic check-up.

After 6 months patients will be readmitted at the neurology department to reperform the same investigations as during the baseline admittance.

Results: 

Fifteen patients with refractory seizures, who are followed at the Reference Centre for Refractory Epilepsy, were screened, fulfilled all criteria and were contacted. 8/15 contacted patients agreed to be admitted and to follow the diet during the initial trial of 6 months with 20 gram carbohydrates a day.

7/8 patients who signed informed consent, started the diet at home as they were taught during admittance, 1/8 never initiated the diet. After 6 months, 3/7 patients were readmitted to perform the final investigations. Four patients quitted the diet earlier. 1 because of illness, 1 because of continuing headache, 1 because of sociofamiliale problems and 1 patient because of a trauma with a fracture of a cervical vertebra. The diet was followed for a mean of 101.9 days (0 – 180). 2/3 patients decided to continue the diet after the initial trial period of six months. After 6 months, 1 patient had >50% seizure reduction.

During 13 of the in total 25 months of diet, minimal once a month patients reported home tested hypoglycemic values (= between 40 and 65 mg/dl). These low values were not confirmed by the lab.

In 1/4 patients, who followed the diet more than 3 months, there was a rise of total cholesterol and low-density lipoproteins (LDL).

Patients, who have followed the diet more than 3 months, lost a mean weight of 10 kg (8,5 – 13,5). Most weight was lost during the first months of the diet.

Side effects (constipation or diarrhoea) were transient and occurred mainly during the initial week of the diet period. Some patients complained about headache, this complain was often reported together with the low glycemic values. On the other hand 6/7 patients mentioned to feel more fit and better able to concentrate.To control patient compliance, urinary ketosis was checked on regularly bases. These results were positive but did not show very high values. The values also decreased during the diet. Together with agenda checking, the ketosis did prove good to very good compliance. Patients feel good during the diet, but also mention it was sometimes quite hard to stick to the rules of the diet.

Conclusion: 

In this prospective pilot trial, the Atkins diet as a treatment for refractory epilepsy in adult patients, showed small seizure reduction. But adult patients can follow the diet in a correct way and most of the patients feel good or even better during the diet. No serious side effects can be reported. Further follow-up of patients included in this study and new studies with more patients included, longer diet periods and controlled design could give more security about the possibility of a significant seizure reduction in adult patients following the Atkins diet as a treatment for refractory epilepsy.