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Modified Atkins diet for drug-resistant epilepsy: A systematic review and meta-analysis of randomized controlled trials

Mutarelli, Antonio, Nogueira, Alleh, Felix, Nicole, Godoi, Amanda, Dagostin, Caroline Serafim, Castro, Luiz H. and Telles, João Paulo Mota 2023. Modified Atkins diet for drug-resistant epilepsy: A systematic review and meta-analysis of randomized controlled trials. Seizure - European Journal of Epilepsy 112 , pp. 77-83. 10.1016/j.seizure.2023.09.010
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Objective To evaluate the effectiveness and side-effect profile of the modified Atkins diet (MAD) compared to the usual diet (UD) in reducing seizure frequency among patients with drug-resistant epilepsy (DRE). Methods In February 2023, we conducted an extensive search in PubMed, EMBASE, and Cochrane databases to find randomized controlled trials (RCTs) comparing MAD to UD in patients with drug-resistant epilepsy (DRE) on standard anti-seizure medication (ASM). We used random-effects meta-analyses and the Risk of Bias 2 tool to evaluate treatment effects and assess the quality of the included RCTs, respectively. Results Six studies were evaluated in the meta-analysis, including 575 patients, of whom 288 (50.1%) were randomized to the MAD. Average follow-up period was 12 weeks. MAD plus standard drug therapy was associated with a higher rate of 50% or greater reduction in seizure frequency compared to UD plus drug therapy (RR 6.28; 95% CI 3.52-10.50; p<0.001), both in children (RR 6.28; 95% CI 3.43-11.49; p<0.001) and adults with DRE (RR 6.14; 95% CI 1.15-32.66; p=0.033). MAD was also associated with a higher seizure freedom rate compared to UD (RR 5.94; 95% CI 1.93-18.31; p=0.002). Five studies reported adverse events with MAD; constipation was reported in 17% of patients (95% CI 5-44%), lethargy in 11% (95% CI 4-25%), and anorexia in 12% (95% CI 8-19%). Due to limited information about the ASM regimens, we were unable to further analyze the interaction between MAD and ASM. Significance This meta-analysis, comprising 575 patients from 6 RCTs, revealed that MAD led to higher rates of seizure freedom and underscored its role in seizure frequency reduction by 50% or more in both adults and children, with no significant adverse events concerns.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: License information from Publisher: LICENSE 1: Title: This article is under embargo with an end date yet to be finalised.
Publisher: Elsevier
ISSN: 1059-1311
Date of First Compliant Deposit: 15 September 2023
Date of Acceptance: 11 September 2023
Last Modified: 04 Oct 2023 14:13

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