Unlocking the Potential Efficacy and Tolerability of Low Glycemic Index Therapy in Drug-Resistant Epilepsy among Children: Systematic Review and Meta-Analysis

BACKGROUND: Drug-resistant epilepsy challenges clinical management, with many patients failing to find relief. Low Glycemic Index Therapy (LGIT) shows promise but lacks clear efficacy data. Clarifying LGIT's effectiveness could ease patient burden and improve seizure management. AIM: To evaluate the efficacy, tolerability, and adverse effects of Low Glycemic Index Therapy (LGIT) as an adjunctive treatment for drug-resistant epilepsy, utilizing a meta-analysis approach. METHODS: We followed a meticulous approach to conducting a meta-analysis on Low Glycemic Index Therapy (LGIT) in drug-resistant epilepsy, leveraging databases such as PubMed, Embase, Scopus, and the Cochrane Library. A total of twelve studies meeting inclusion criteria were identified. Comprehensive search terms and filters were applied to retrieve relevant data. Two independent reviewers meticulously screened titles, abstracts, and full texts, ensuring adherence to predefined criteria. Data extraction encompassed study characteristics, participant demographics, intervention details, and outcomes, including seizure frequency, %reduction, and adverse events. Quality assessment utilized established tools like the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Statistical analyses incorporated mean differences, risk ratios, and sensitivity/subgroup analyses. Ethical considerations were upheld, and reporting followed PRISMA guidelines. Limitations, including potential biases and heterogeneity, were acknowledged, with sensitivity analyses conducted to enhance findings' validity. This systematic methodology ensures a comprehensive evaluation of LGIT's efficacy, tolerability, and adverse effects in drug-resistant epilepsy patients. RESULTS: Variations in adverse effects and compliance further highlight heterogeneous responses to LGIT. Despite promising results, limitations include study design variability and short follow-up durations, potentially affecting generalizability and long-term outcomes assessment. Mean and risk differences across twelve studies investigating Low Glycemic Index Therapy (LGIT) in drug-resistant epilepsy showed significant reductions in seizure frequency were observed with LGIT compared to control groups (mean difference: -1.97 [-3.48, -0.47], Z = 2.56, p = 0.01). Heterogeneity analysis revealed substantial variability (Tau² = 2.04, Chi² = 49.89, df = 3, I² = 86%). Funnel plots further underscored LGIT's efficacy, with a mean difference of 4.80 [1.98, 7.61] favoring experimental interventions. However, heterogeneity remained considerable (Tau² = 6.20, Chi² = 7.14, df = 4, I² = 63%). Risk differences favored LGIT but were not statistically significant (total: -0.11 [-0.35, 0.13], Z = 0.89, p = 0.37). CONCLUSIONS: Diverse study designs and participant cohorts provide insights into LGIT's efficacy, tolerability, and adverse effects. Notably, LGIT consistently reduces seizure frequency across studies, as evidenced by significant results in multiple investigations.