The role of the “classic” ketogenic diet in the management of childhood epilepsy is well established (Wilder, 1921; Henderson et al., 2006; Freeman et al., 2007; Neal et al., 2008). There is a growing body of evidence from the pediatric population suggesting that a diet that promotes ketosis by severely restricting carbohydrate intake may also be helpful in reducing the frequency of pharmacoresistant seizures (Kossoff & Dorward, 2008; Kossoff et al., 2008; Muzykewicz et al., 2009). The Atkins Diet has been popularized in the media and calls for severe carbohydrate restriction in its “initiation phase” (Atkins, 2002). A Modified Atkins Diet (MAD) has been developed as a potential cotherapy for patients with intractable epilepsy (Kossoff & Dorward, 2008). Unlike the Atkins Diet, the MAD prolongs the initial severe carbohydrate restriction phase indefinitely, and the primary goal of the diet is improved seizure control, not weight loss. The MAD also differs from the Atkins Diet in that liberal fat intake is allowed and encouraged if weight gain is desirable. This diet is less complex and more palatable than a traditional ketogenic diet and, therefore, may be associated with greater compliance in adolescent and adult patient populations (Kossoff et al., 2008). There is still very little known about the efficacy of the MAD in the treatment of medically refractory epilepsy in the adult patient.
This study purports to contribute to previous work in this field intended to determine (1) if the MAD is an effective and sustainable method of cotherapy in intractable epilepsy in an adult population and (2) whether compliant patients show health gains beyond greater seizure control. Previous studies following patients for 6 months on the MAD report modest results, with approximately one third of patients experiencing >50% decrease in seizure frequency (Carrette et al., 2008; Kossoff et al., 2008). Our study adds to these reports by following patients over a longer period on the MAD, and tracking changes in body mass index (BMI) and weight during this time.