Effectiveness of the Modified Atkins Diet in Children with Epilepsy: A Systematic Review

Introduction: Epilepsy is a common disorder that greatly increases morbidity due to its chronic, recurring, and unprovoked seizures. Therefore, Alternative non-pharmacological non-surgical therapy options are required for these people. Thus, we conducted a systematic review to assess the independent effects of MAD on food tolerability and seizure reduction in children with epilepsy. Methods: A systematic review was conducted with an online database in accordance with PRISMA guidelines. The inclusion criteria set include studies that implemented a modified Atkins diet or its variant in children or adolescents with epilepsy. The exclusion criteria were studied not available in full text and not available in English. Studies from 2005-2023 investigating MAD or its variants in children with epilepsy were included. Randomized controlled trials (RCTs), prospective and retrospective studies, and clinical trials were eligible. Quality assessment employed the Newcastle-Ottawa Scale (NOS) for cohort studies and the RoB 2 tool for RCTs. Results: Nine studies (n=634 children) met inclusion criteria. After one month, 63% of participants experienced a seizure reduction of more than 50%, and 27% achieved seizure freedom. At three months, 55% had a seizure reduction of over 50%, and 21% were seizure-free. By six months, 25% showed a seizure reduction exceeding 50%, with 15% achieving seizure freedom. The Modified Atkins Diet (MAD) exhibited good tolerability, with adverse events, such as gastrointestinal disturbances and elevated cholesterol levels, being generally manageable. Compliance rates varied among the studies. Conclusion: MAD shows potential as a tolerable dietary therapy for seizure reduction in children diagnosed with epilepsy, especially in DRE cases. However, the long-term efficacy and optimal implementation require further investigation. Larger, well-designed RCTs with longer follow-up periods are needed to confirm these findings and establish clear guidelines for MAD use in pediatric epilepsy management.