Table 1.
Summary of studies involving children treated with MAD.
| Authors | Study type | Sample size | Age range | Epilepsy | At 3 months | Adverse effects | |
|---|---|---|---|---|---|---|---|
| >50% | >90% | ||||||
| Kossoff et al. 2003 [12] | Open trial | 6 | 7–52 yrs | Mixed | 3 | — | Not reported |
| Kossoff et al. 2006 [13] | Prospective | 20 | 3–18 yrs | ≥3 Sz/week on at least 2 AEDs | 50% | 11% | Constipation |
| Kossoff et al. 2007 [18] | Randomized cross-over (10 g versus 20 g) | 20 | 3–18 yrs | At least daily countable seizures | 10 g—60% 20 g—10% |
10 g—30% 20 g—0% |
Improved tolerability with 20 g |
| Kang et al. 2007 [14] | Prospective | 14 | Mean 7.4 yrs | ≥4 Sz/month; ≥3 AEDs | 50% | 29% | Gastrointestinal disturbances |
| Porta et al. 2009 [19] | Retrospective | 27 | 4–182 months | ≥2 Sz/week, ≥3 AEDs |
KD—64% MAD—20% |
— | Mild digestive disorders |
| Weber et al. 2009 [20] | Prospective | 15 | 2–17 yrs | ≥1 Sz/week, ≥2 AEDs |
40% | 13% | Not significant |
| Tonekaboni et al. 2010 [21] | Prospective | 27 | 1–16 yrs | ≥3 AEDs tried | 67% | 25% | Minor |
| Miranda et al. 2010 [22] | Prospective | 33 | 1–16 yrs | Medically intractable epilepsy | 52% | 42% | Subtle |
| Kossoff et al. 2011 [23] | Prospective (MAD + 1 month Ketocal) |
30 | 3–18 yrs | At least daily countable seizures; ≥2 AEDs |
At 1 month, 80% At 2 months, 70% |
37% 43% |
Constipation |
| Groomes, et al. 2011 [24] | Retrospective + prospective | 21 (8-ketogenic diet, 13-MAD) |
Median age at diet onset—6 yrs | Intractable childhood and juvenile absence epilepsy | 82% | 38% | Not mentioned |
| Kumada et al. 2012 [25] | Prospective | 10 | 1.5–17 yrs | ≥3 Sz/week, ≥3 AEDs |
At 3 weeks, 3 | 2 | |
| Sharma et al. 2012 [26] | Prospective | 15 | 6 m–3 yrs | Daily infantile spasms | 40% spasm free | Constipation | |
| Kim et al. 2012 [27] | Retrospective | 20 | 21 m–17 yrs | Mixed | 55%* | 35%* | Constipation, hypercalciuria, hyperuricemia, transient lipase elevation |
| Sharma et al. 2013 [28] | Randomized controlled trial | Total 102, 50 randomized to diet group | 2–14 yrs | Daily seizures, or at least 7/week | 52% in diet group versus 11.5% in control group | 30% in diet group versus 7.7% in control group | Constipation, anorexia, vomiting, lethargy |
*Efficacy during the recent or final 3 months of the diet therapy.
AEDs: antiepileptic drugs; Sz: seizures; MAD: modified Atkins diet; KD: ketogenic diet.