In a limited study of three 12-year-olds and three younger patients on the Atkins regimen for at least four months, two children and one young adult were seizure-free and were able to reduce use of anti-convulsant medications.
Findings of the study, presented yesterday at the American Epilepsy Society Meeting in Boston, also showed that seizure control could be long-lasting on the diet, with the three patients continuing to be seizure-free for as long as 20 months.
The researchers caution that because of the small number of study subjects, their look at the relationship between the Atkins diet and seizure control should not lead to its routine use in children with epilepsy, nor at this point should the Atkins diet be used to replace the ketogenic diet, a rigorous high-fat, low-carbohydrate diet already proven to reduce or eliminate difficult-to-control seizures in some patients.
The common elements in both diets are high fat and low carbohydrate foods that alter the body's glucose chemistry. The ketogenic diet mimics some of the effects of starvation, in which the body first uses up glucose and glycogen before burning stored body fat. In the absence of glucose, the body produces ketones, a chemical byproduct of fat that can inhibit seizures. Children who remain seizure-free for two years on the ketogenic diet often can resume normal eating and often their seizures don't return. The Atkins diet, while slightly less restrictive than the ketogenic diet, also produces ketones.
"We just don't know yet how effective the Atkins diet is in reducing seizures or if it comes close to the benefits of the ketogenic diet, but our report raises new questions about the ideal level of calorie and protein restriction imposed by the ketogenic diet," said the study's lead author, Eric Kossoff, a pediatric neurologist at the Children's Center.
"By learning more about how the Atkins diet works to control seizures, we should learn more about which patients may benefit best from either or both of these diets," he added. "It may be, for example, that some of those who can't tolerate the restrictiveness of the ketogenic diet could be helped with Atkins."
In the short term, Kossoff says that the Atkins diet could be used in selected patients as a 'trial run' for individuals considering the ketogenic diet in the future.
"Success on the Atkins diet may be a good indication of patient compliance and efficacy of the ketogenic diet," he added. "Because the Atkins diet is easy to read and versions of it are available in paperback at bookstores, families can easily follow this kind of a strict, low-carbohydrate diet on their own for several weeks to determine if this is something they can adhere to."
Kossoff noted that patients following the Atkins diet to reduce seizures may lose weight in the process. In this case the patient should be instructed to increase calorie intake by eating more fats and proteins.
In the Hopkins study, patients began with 10 grams of carbohydrates per day, more than the typical amount provided on the ketogenic diet, but fewer than used in the induction phase of the Atkins diet (20 grams/day). Carbohydrate intake was gradually increased for some patients. Five out of the six patients attained ketosis (the state of producing ketones) within days of starting the Atkins diet and maintained moderate to large levels of ketosis for periods of six weeks to 24 months.
Hopkins researchers will further examine the potential of the diet in a larger clinical study of 20 children with epilepsy, which began in September 2003 and already has enrolled several patients.