Efficacy and safety of modified Atkins diet therapy for drug-resistant epilepsy in children and adults: A systematic review and meta-analysis

Introduction: Diet-based treatments have been proposed for drug-resistant epilepsy (DRE), and the Modified Atkins Diet (MAD) is an alternative. This study aimed to assess the efficacy and safety of MAD as an adjunctive therapy for reducing seizures in patients with drug-resistant epilepsy.Methods: A literature search was done on six databases. Randomized controlled trial (RCT) studies were included, comparing DRE patients of all ages on standard antiseizure medications (ASD) who received MAD compared to no-dietary or other dietary interventions. The outcomes are the seizure frequency reduction and the adverse events. Cochrane risk-of-bias tool and GRADE were used to assess study quality and the overall certainty of evidence. The effect size of the efficacy of MAD was computed as risk ratio (95% CI). Subgroup analysis based on each type of comparator was done.Results: Ten RCT studies (905 participants) were included, comparing MAD to no dietary intervention, ketogenic diet (KD), and low glycemic index treatment (LGIT). Overall, MAD is constantly and significantly more efficacious than no dietary intervention in reducing seizures >= 50% (RR 7.90, 95% CI 4.59-13.62), >= 90% (RR 4.61, 95% CI 2.05-10.36), and inducing complete seizure-free (RR 7.79, 95% 2.61-23.22) with high certainty. Other dietary therapies and MAD did not differ significantly from one another in terms of efficacy. The risk of adverse events in MAD is insignificantly higher than in others (RR 1.19, 95% 0.92-1.55).Conclusion: The Modified Atkins Diet has better seizure reduction than no diet intervention but is comparable to other dietary interventions with a negligible increased risk of adverse events.