Comments on the Effect of the Classic Ketogenic Diet Versus the Modified Atkins Diet Over Electroencephalogram Findings in Children with Refractory Epilepsy

Dear Editor, We read with interest the article “Effect of Classic Ketogenic Diet Versus Modified Atkins Diet over Electro-Encephalogram Findings in Children with Refractory Epilepsy” published in May-Jun 2024 - Volume 17 - Issue 3.[1] We congratulate all the authors of this study. However, we would like to address some questions regarding the above article. The ketogenic diet has been in vogue since 1928.[2] Recent studies have found a significantly positive outcome with the use of the KD for the treatment of refractory epilepsy in children and adults.[3] In the last 20 years, new variants of the KD diet have emerged, including the Modified Atkins diet (MAD), which allows more protein and does not restrict calories and fluids. Several studies have shown that the new variants of the KD have a similar efficacy to the CKD.[4,5] Regardless of the efficacy of the KD, most patients discontinue the diet because of its unpalatable and restrictive features,[6] as even in this study the drop-out rate was quite high, ranging from 13.6% to 18.2% in KD and 28.6% to 38.1% in the MAD diet group. Even in diseases like DM, long-term compliance with dietary restrictions is known to be poor.[7] However, the authors should be congratulated for a good study in epilepsy, with EEG as a parameter. Data availability statement Please contact corresponding author for any data required. Author contribution All authors contributed equally to reviewing the literature; analysis, interpretation of data and drafting the article. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.