The efficacy comparison of classic ketogenic diet and modified Atkins diet in children with refractory epilepsy: a clinical trial

  • Bita Poorshiri
  • Mohammad BarzegarEmail author
  • Sanaz Tahmasebi
  • Shadi Shiva
  • Sina Raeisi
  • Zakiyeh Ebadi
Original article


Dietary therapy has an important role in the therapeutic process in children suffering refractory epilepsy. There are two kinds of dietary therapy which are the most common in children with refractory epilepsy: The classic ketogenic diet (KD) and the modified Atkins diet (MAD). The purpose of the present study was to compare the efficacy, tolerability, and compliance of these two dietary therapies in the children who have refractory epilepsy during 6 months of treatment. From March 2017 to November 2018, 45 children aged 2–15 years who had refractory epilepsy were randomly allocated in KD or MAD group. The intervention period was 6 months in both groups. The frequencies of seizures were determined from parental reports and were compared between the groups. The patients with upper than 50% reduction in seizure frequency were deemed as responders to the diets. Twenty-four patients were assigned to the KD and 11 patients to the MAD. Overall, 45.8% of children treated with the KD and 45.5% of children treated with MAD had over than 50% response to the diet therapies. The difference was not statistically significant (P = 0.437). The MAD was more advantageous regarding better tolerability and fewer side effects. There is not much difference regarding the efficacy between the MAD and classic KD. The MAD with fewer side effects may be more suitable as the first line of dietary therapy in children with refractory epilepsy.


Epilepsy Modified Atkins diet Classic ketogenic diet Antiepileptic drugs 



This work was supported by Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Author contributions

All authors contributed to the study conception and design. The first draft of the manuscript was written by BP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.


This study was not funded.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The trial protocol has been approved by the Medical Ethics Committee of Tabriz University of Medical Sciences (reference number: IR.TBZMED.REC.1396.1108) and registered in the Iranian Registry of Clinical Trials (IRCT registration number: IRCT20131012014988N5). The authors declare that they comply with the Principles of Ethical Publishing.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Wirrell EC, Wong-Kisiel LC, Mandrekar J, Nickels KC (2013) What predicts enduring intractability in children who appear medically intractable in the first 2 years after diagnosis? Epilepsia 54(6):1056–1064. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Geerts A, Brouwer O, Stroink H, van Donselaar C, Peters B, Peeters E, Arts WF (2012) Onset of intractability and its course over time: the Dutch study of epilepsy in childhood. Epilepsia 53(4):741–751. CrossRefPubMedGoogle Scholar
  3. 3.
    Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, Moshe SL, Perucca E, Wiebe S, French J (2010) Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 51(6):1069–1077. CrossRefPubMedGoogle Scholar
  4. 4.
    Freeman JM, Kossoff EH, Hartman AL (2007) The ketogenic diet: one decade later. Pediatrics 119(3):535–543. CrossRefPubMedGoogle Scholar
  5. 5.
    Neal EG, Chaffe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G, Whitney A, Cross JH (2008) The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol 7(6):500–506. CrossRefPubMedGoogle Scholar
  6. 6.
    Hartman AL, Gasior M, Vining EP, Rogawski MA (2007) The neuropharmacology of the ketogenic diet. Pediatr Neurol 36(5):281–292. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Mehdizadeh A, Barzegar M, Negargar S, Yahyavi A, Raeisi S (2019) The current and emerging therapeutic approaches in drug-resistant epilepsy management. Acta Neurol Belg 119(2):155–162. CrossRefPubMedGoogle Scholar
  8. 8.
    Coppola G, Veggiotti P, Cusmai R, Bertoli S, Cardinali S, Dionisi-Vici C, Elia M, Lispi ML, Sarnelli C, Tagliabue A, Toraldo C, Pascotto A (2002) The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience. Epilepsy Res 48(3):221–227. CrossRefPubMedGoogle Scholar
  9. 9.
    Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM (1998) The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children. Pediatrics 102(6):1358–1363. CrossRefPubMedGoogle Scholar
  10. 10.
    Park EG, Lee J, Lee J (2018) Use of the modified Atkins diet in intractable pediatric epilepsy. J Epilepsy Res 8(1):20–26. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Miranda MJ, Mortensen M, Povlsen JH, Nielsen H, Beniczky S (2011) 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 20(2):151–155. CrossRefPubMedGoogle Scholar
  12. 12.
    Tonekaboni SH, Mostaghimi P, Mirmiran P, Abbaskhanian A, Abdollah Gorji F, Ghofrani M, Azizi F (2010) Efficacy of the Atkins diet as therapy for intractable epilepsy in children. Arch Iran Med 13(6):492–497. CrossRefPubMedGoogle Scholar
  13. 13.
    Porta N, Vallee L, Boutry E, Fontaine M, Dessein AF, Joriot S, Cuisset JM, Cuvellier JC, Auvin S (2009) Comparison of seizure reduction and serum fatty acid levels after receiving the ketogenic and modified Atkins diet. Seizure 18(5):359–364. CrossRefPubMedGoogle Scholar
  14. 14.
    Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, Engel J Jr, Forsgren L, French JA, Glynn M (2014) ILAE official report: a practical clinical definition of epilepsy. Epilepsia 55(4):475–482. CrossRefPubMedGoogle Scholar
  15. 15.
    Kossoff EH (2004) More fat and fewer seizures: dietary therapies for epilepsy. Lancet Neurol 3(7):415–420. CrossRefPubMedGoogle Scholar
  16. 16.
    D’Andrea Meira I, Romão TT, Pires do Prado HJ, Krüger LT, Pires MEP, da Conceição PO (2019) Ketogenic diet and epilepsy: what we know so far. Front Neurosci 13:5. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ghazavi A, Tonekaboni SH, Karimzadeh P, Nikibakhsh AA, Khajeh A, Fayyazi A (2014) The ketogenic and atkins diets effect on intractable epilepsy: a comparison. Iran J Child Neurol 8(3):12–17PubMedPubMedCentralGoogle Scholar
  18. 18.
    Jagadish S, Payne ET, Wong-Kisiel L, Nickels KC, Eckert S, Wirrell EC (2019) The ketogenic and modified Atkins diet therapy for children with refractory epilepsy of genetic etiology. Pediatr Neurol 94:32–37. CrossRefPubMedGoogle Scholar
  19. 19.
    Kim JA, Yoon JR, Lee EJ, Lee JS, Kim JT, Kim HD, Kang HC (2016) Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy. Epilepsia 57(1):51–58. CrossRefPubMedGoogle Scholar
  20. 20.
    Kossoff EH, McGrogan JR, Bluml RM, Pillas DJ, Rubenstein JE, Vining EP (2006) A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia 47(2):421–424. CrossRefPubMedGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  1. 1.Pediatric Health Research CenterTabriz University of Medical SciencesTabrizIran

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