Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis

Fang Ye, Xiao-Jia Li, Wan-Lin Jiang, Hong-Bin Sun, Jie Liu, Fang Ye, Xiao-Jia Li, Wan-Lin Jiang, Hong-Bin Sun, Jie Liu

Abstract

Background and purpose: Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice.

Methods: Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies of the efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy; the included studies were reviewed. Meta-analyses were performed using STATA to determine combined efficacy rates and combined rates of compliance with the ketogenic diet and its main subtypes.

Results: In total, 12 studies qualified for inclusion, and data from 270 patients were evaluated.The results of the meta-analysis revealed combined efficacy rates of all types of ketogenic diet, a classical ketogenic diet, and a modified Atkins diet were 42%, 52%, and 34%, respectively; the corresponding combined compliance rates were 45%, 38%, and 56%.

Conclusions: The results indicate that a ketogenic diet is a promising complementary therapy in adult intractable epilepsy, and that while a classical ketogenic diet may be more effective, adult patients are likely to be less compliant with it than with a modified Atkins diet.

Keywords: adult; compliance; efficacy; intractable epilepsy; ketogenic diet.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of studies included and excluded. KD: ketogenic diet.
Fig. 2
Fig. 2
The forest and funnel plots of the combined efficacy rates of ketogenic diet and its variants. CI: confidence interval, CKD: classical ketogenic diet, MAD: modified Atkins diet, MCT: medium-chain triglycerides diet, N: number of total subjects, n: number of patients achieving success in total subjects, % weight: percentage that each study counts in the results of the meta-analysis.
Fig. 3
Fig. 3
The forest and funnel plots of the combined compliance rates of ketogenic diet and its variants. CI: confidence interval, CKD: classical ketogenic diet, MAD: modified Atkins diet, MCT: medium-chain triglycerides diet, % weight: percentage that each study counts in the results of the meta-analysis.

References

    1. Wilder RM. The effects of ketonemia on the course of epilepsy. Mayo Clin Bull. 1921;2:307–308.
    1. Cervenka MC, Kossoff EH. Dietary treatment of intractable epilepsy. Continuum (Minneap Minn) 2013;19(3 Epilepsy):756–766.
    1. Kossoff EH, McGrogan JR, Bluml RM, Pillas DJ, Rubenstein JE, Vining EP. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia. 2006;47:421–424.
    1. Kossoff EH, Hartman AL. Ketogenic diets: new advances for metabolism-based therapies. Curr Opin Neurol. 2012;25:173–178.
    1. Kossoff EH, Cervenka MC, Henry BJ, Haney CA, Turner Z. A decade of the modified Atkins diet (2003-2013): Results, insights, and future directions. Epilepsy Behav. 2013;29:437–442.
    1. Lee PR, Kossoff EH. Dietary treatments for epilepsy: management guidelines for the general practitioner. Epilepsy Behav. 2011;21:115–121.
    1. Kwan P, Schachter SC, Brodie MJ. Drug-resistant epilepsy. N Engl J Med. 2011;365:919–926.
    1. Barborka CJ. Epilepsy in adults: results of treatment by ketogenic diet in one hundred cases. Arch Neurol Psychiatry. 1930;23:904–914.
    1. Sirven J, Whedon B, Caplan D, Liporace J, Glosser D, O'Dwyer J, et al. The ketogenic diet for intractable epilepsy in adults: preliminary results. Epilepsia. 1999;40:1721–1726.
    1. Mosek A, Natour H, Neufeld MY, Shiff Y, Vaisman N. Ketogenic diet treatment in adults with refractory epilepsy: a prospective pilot study. Seizure. 2009;18:30–33.
    1. Klein P, Janousek J, Barber A, Weissberger R. Ketogenic diet treatment in adults with refractory epilepsy. Epilepsy Behav. 2010;19:575–579.
    1. Cervenka MC, Henry B, Nathan J, Wood S, Volek JS. Worldwide dietary therapies for adults with epilepsy and other disorders. J Child Neurol. 2013;28:1034–1040.
    1. Nei M, Ngo L, Sirven JI, Sperling MR. Ketogenic diet in adolescents and adults with epilepsy. Seizure. 2014;23:439–442.
    1. Carrette E, Vonck K, de Herdt V, Dewaele I, Raedt R, Goossens L, et al. A pilot trial with modified Atkins' diet in adult patients with refractory epilepsy. Clin Neurol Neurosurg. 2008;110:797–803.
    1. Kossoff EH, Rowley H, Sinha SR, Vining EP. A prospective study of the modified Atkins diet for intractable epilepsy in adults. Epilepsia. 2008;49:316–319.
    1. Smith M, Politzer N, Macgarvie D, McAndrews MP, Del Campo M. Efficacy and tolerability of the modified Atkins diet in adults with pharmacoresistant epilepsy: a prospective observational study. Epilepsia. 2011;52:775–780.
    1. Cervenka MC, Terao NN, Bosarge JL, Henry BJ, Klees AA, Morrison PF, et al. E-mail management of the modified Atkins Diet for adults with epilepsy is feasible and effective. Epilepsia. 2012;53:728–732.
    1. Kossoff EH, Henry BJ, Cervenka MC. Efficacy of dietary therapy for juvenile myoclonic epilepsy. Epilepsy Behav. 2013;26:162–164.
    1. Lambrechts DA, Wielders LH, Aldenkamp AP, Kessels FG, de Kinderen RJ, Majoie MJ. The ketogenic diet as a treatment option in adults with chronic refractory epilepsy: efficacy and tolerability in clinical practice. Epilepsy Behav. 2012;23:310–314.
    1. Payne NE, Cross JH, Sander JW, Sisodiya SM. The ketogenic and related diets in adolescents and adults--a review. Epilepsia. 2011;52:1941–1948.
    1. Miranda MJ, Mortensen M, Povlsen JH, Nielsen H, Beniczky S. Danish study of a modified Atkins diet for medically intractable epilepsy in children: can we achieve the same results as with the classical ketogenic diet? Seizure. 2011;20:151–155.
    1. El-Rashidy OF, Nassar MF, Abdel-Hamid IA, Shatla RH, Abdel-Hamid MH, Gabr SS, et al. Modified Atkins diet vs classic ketogenic formula in intractable epilepsy. Acta Neurol Scand. 2013;128:402–408.
    1. Kossoff EH, Bosarge JL, Miranda MJ, Wiemer-Kruel A, Kang HC, Kim HD. Will seizure control improve by switching from the modified Atkins diet to the traditional ketogenic diet? Epilepsia. 2010;51:2496–2499.
    1. Auvin S. Should we routinely use modified Atkins diet instead of regular ketogenic diet to treat children with epilepsy? Seizure. 2012;21:237–240.

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