, et al
Evaluation of the modified Atkins diet for the treatment of epileptic spasms refractory to hormonal therapy: a randomized controlled trial
J Child Neurol
; doi:

Investigators from New Delhi, India, conducted a randomized controlled trial to assess the effect of a modified Atkins diet on infantile spasms refractory to treatment. Children were eligible if they were: (a) 9 months to 3 years old; (b) treated at the study hospital for infantile spasms; and (c) having daily infantile spasms for at least 4 weeks with EEG evidence of hypsarrhythmia despite a trial of ACTH or oral prednisolone and 1 additional anticonvulsant. Children with known or suspected metabolic disorders or severe malnutrition were excluded. Demographics were collected at baseline.

Participants were randomized to either the diet group or a control group. In the diet group, parents were instructed to feed their child a modified Atkins diet for 4 weeks, in which carbohydrate intake was restricted to 5 g/d in children 9-18 months and 10 g/day in children 18 months to 3 years. Fat intake was encouraged, and protein and calorie intake were not restricted. The control group received their normal diet. Ongoing anticonvulsants were continued.

Parents of participants in the diet group completed a 24-hour dietary recall before study visits at 1, 2, and 4 weeks after the start of the intervention period. Calorie and carbohydrate intake was reviewed at these study visits to reinforce compliance. Parents in both groups maintained a daily log recording infantile spasms.

The primary outcome was the proportion of children who were spasm-free per parent-completed spasm logs at 4 weeks. Secondary outcomes included the proportion of children with ≥50% reduction of spasms at 4 weeks as well as side effects in the diet group. Investigators compared spasm outcomes between diet and control group participants using an intention to treat analysis.

There were 91 children enrolled, 46 in the diet group and 45 in the control group. There were no statistically significant differences in demographics between groups at baseline. The median baseline spasm frequency among participants in the diet group was 60 per day and 50 per day in the control group.

At the end of 4 weeks, significantly more participants in the diet (vs control) group were spasm-free (11 vs 0; P < 0.001); 9 of these also had resolution of hypsarrhythmia on EEG. There also was a significantly higher proportion of participants who had ≥50% reduction in spasms in the diet (vs control) group (65.2% vs 0%; P < 0.001). The most common side effect reported was constipation (34.8%).

The investigators conclude that the modified Atkins diet is well-tolerated and effective in reducing infantile spasms refractory to therapy.

Dr Candee has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial...

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