Modified Atkins Diet versus low glycemic index treatment in children with drug-resistant epilepsy: A systematic review and meta-analysis.

Introduction: Both the Modified Atkins Diet (MAD) and Low Glycemic Index Treatment(LGIT) are considered less restrictive than the ketogenic diet and effective in children with drug-resistant epilepsy(DRE). Several randomized controlled trials (RCTs) have compared these two diets.

Methods: All RCTs directly comparing MAD and LGIT for DRE were included in the review. We pooled estimates for percentage seizure frequency reduction, the number of participants with seizure freedom, ≥90 % and ≥50 % reduction in seizure frequency, as well as changes in cognition, behavior, and adverse effects in both groups.

Results: Three RCTs with 265 participants were included. The pooled estimates for the number of children achieving seizure freedom, ≥50 %, and ≥90 % reduction in seizure frequency post-intervention, as well as weekly percentage seizure frequency reduction, were comparable between the MAD and LGIT groups(RR: 1.24 [95 % CI: 0.71-2.16]; I²=0 %, p = 0.45, RR: 0.86 [95 % CI: 0.57-1.29]; I²=62 %, p = 0.45, RR: 1.35 [95 % CI: 0.82-2.21]; I²=5 %, p = 0.24, and MD:6.5 [95 % CI:13.8 to 0.6]; I²=45 %, p = 0.07). The number of children showing improvement in cognition and changes in behavioral comorbidities were also comparable between the groups(p = 0.60 and 0.21). However, the MAD group had a higher incidence of adverse effects(RR: 1.37 [95 % CI: 1.12-1.68]; I²=42 %, p = 0.002), though the number of participants experiencing serious adverse effects was similar in both groups(RR: 1.68 [95 % CI: 0.71-3.99]; I²=0 %, p = 0.24). Adherence rates to the allocated intervention were numerically higher in the LGIT group(p = 0.73).

Conclusion: Both MAD and LGIT are comparable in efficacy, but LGIT is associated with fewer adverse effects.