Efficacy and Safety of the Modified Atkins Diet Versus the Ketogenic Diet in Treating Pediatric Epilepsy: A Systematic Review and Meta-analysis
Ahmed Hashem Fathallah1, Mohamed Mamdouh2, Ibrahim Kamal3, Ahmed Elfeky2, Mohamed Nabil Nady2, Mahmoud Ahmed Rabea2, Esraa Ragaey2, Lobna Hany Goma2, Mohamed Ahmed Ali2, Yasmin Safwat2, Anas Nourelden3
1Faculty of Medicine, Minia University, Minia, Egypt., 2Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt, 3Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Objective:
This study aimed to compare the efficacy and safety of MAD versus KD in reducing pediatric seizure burdens.
Background:
One-third of patients with epilepsy have drug-resistant seizures. For these cases, non-pharmacological approaches, such as ketogenic diets, are used. The Modified Atkins Diet (MAD) is a more flexible, less restrictive alternative to the classic Ketogenic Diet (KD), allowing unlimited fat and protein without calorie restriction.
Design/Methods:
A comprehensive search was performed for relevant articles published up to September 2025 using the PubMed, Scopus, Web of Science, and Cochrane Library databases. Data extraction from the selected studies was conducted independently by two reviewers. The extracted data encompassed baseline study characteristics, outcomes, seizure frequency, and the number of participants who attained 50%, 90%, and complete seizure freedom. All statistical analyses were conducted utilizing R v4.3.3.
Results:
The following study included 28 RCTs to compare the safety and efficacy of MAD vs. KD in managing pediatric epilepsy. Our analysis demonstrated that a 50% reduction in seizure frequency within 24 weeks was achieved by 43% on KD and 53% on the MAD, without a statistically significant difference (p=0.2753). Beyond 24 weeks, the 50% responder rate was 51% for KD and 37% for MAD (p=0.1153). For a 90% reduction, no significant differences were found between diets at either time point (p=0.2170, p=0.1503, respectively). KD decreased seizure frequency by a mean of -7.67 events/day compared to -7.47 for MAD (p=0.9284). No significant differences were found between the KD and MAD regarding seizure freedom (25% vs. 19%, p=0.3252).
Conclusions:
Our analysis suggested that KD and MAD demonstrate statistically comparable efficacy for reducing seizures in pediatric drug-resistant epilepsy. Given its less restrictive nature, better tolerability, and potential for higher compliance, MAD is a viable first-line dietary therapy.
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