A modified Atkins diet appears to be an effective and well-tolerated therapy for children with intractable epilepsy, based on results from this small, open-label prospective study. At the 6-month period, 65% had a >50% response, and 35% had a >90% response. A striking similarity exists to a large published prospective study of the traditional ketogenic diet, in which 51% had a >50% response and 32% had >90% seizure reduction, with an intent-to-treat analysis (11). Also in that study, 71% were able to stay on the diet for 6 months, similar to the 80% in this study.
This study raises important questions on the current use of the traditional ketogenic diet. The first is whether higher ratios with more fat, less protein, and fewer carbohydrates are truly necessary for efficacy. Our results also question whether ketosis is as important as previously reported (10,12). Eighty percent of children with a loss of large urinary ketosis over the study period did not lose seizure control, and the same percentage with trace or zero ketosis at 6 months were still improved. Preliminary efficacy of a low–glycemic index diet with lower levels of ketosis also suggests this may be accurate (13).