Objective:

To describe a case of a patient with refractory epilepsy who was maintained on a Modified Atkins Diet (MAD) as an adjunct treatment throughout pregnancy.

Background:

Approximately 30% of patients with epilepsy have intractable epilepsy, with a certain subset of these patients becoming pregnant. This highlights the importance of alternative non-pharmacological therapies that can be safely used during pregnancy. Current guidelines do not recommend MAD or ketogenic diet (KD) during pregnancy due to concerns about potential risks to fetal health. However, only two cases have been reported of diet therapy in pregnant patients with epilepsy. Therefore, more data are needed.

Design/Methods:

NA

Results:

A 25-year-old female with refractory primary generalized epilepsy, treated with vagus nerve stimulation, levetiracetam, lamotrigine, ethosuximide, and clobazam, initiated a MAD with 30 grams of carbohydrate per day as adjunctive therapy. She began the MAD due to persistent seizures occurring every two months. Three months into the diet, she became pregnant and opted to continue MAD, increasing carbohydrate intake to 15-20 grams per meal to meet the increased metabolic demands of pregnancy. She achieved 10 months of seizure freedom until three breakthrough seizures occurred in the third trimester, necessitating an increase in lamotrigine. She delivered vaginally at 37 weeks due to oligohydramnios and discontinued MAD for breastfeeding, remaining seizure-free for over a year. In her subsequent pregnancy, she did not resume MAD, and experienced two breakthrough seizures in the second trimester, resulting in an increase in levetiracetam. Both children demonstrate normal neurodevelopment at 50 and 37 months of age.

Conclusions:

This is the second reported case of MAD therapy during pregnancy. While there was significant seizure reduction with the initiation of MAD, the patient developed oligohydramnios. Thus, the safety and efficacy of MAD during pregnancy remain uncertain, warranting further investigation.