Low-carbohydrate diet effective in juvenile myoclonic epilepsy

By Joanna Lyford, Senior medwireNews Reporter

Dietary modification can be an effective adjunct to drugs in people with juvenile myoclonic epilepsy (JME), according to a study reported in Epilepsy & Behavior.

The study found that children and adults who were able to follow the modified Atkins Diet for at least 1 month experienced a significant reduction in the frequency of seizures.

"Further studies are needed to compare the relative feasibility and efficacy of these treatments in this patient population," write Eric Kossoff (The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA) and fellow researchers.

Kossoff's team retrospectively analyzed outcomes of eight patients with JME who were treated with the modified Atkins Diet at Johns Hopkins Hospital.

This diet - which is based on the original Atkins diet but with a lower carbohydrate limit compared with the Atkins recommendations and an emphasis on high-fat foods - has been reported as effective for idiopathic generalized epilepsy, note the researchers, and has potential advantages over a ketogenic diet due to being less restrictive and easier to manage.

"To our knowledge, the use of dietary therapy for JME has only previously been reported in a single patient, who was noted to be a responder at 3 months," they add.

Among the eight individuals in the current study, of whom six were women, the mean age at disease onset was 10.5 years, and the mean age at initiation of dietary therapy was 24.3 years. Patients had previously tried 5.4 different anticonvulsant drugs, on average, and most were taking one or two at the time of starting the diet.

All patients had a clinical history of myoclonic seizures and most experienced absence and generalized tonic-clonic seizures with characteristic spike-wave and polyspike-wave findings on electroencephalography.

Dietary therapy comprised a daily carbohydrate intake of 10 g for adolescent patients and 20 g for adults, with high-fat foods being encouraged. Five patients also received a ketogenic diet formula.

Within a few days of starting the diet, seven of the patients achieved at least moderate urinary ketosis, report Kossoff and co-authors. After 1 month, seven patients remained on the diet, while one had discontinued citing restrictiveness.

In terms of efficacy, six patients had at least a 50% reduction in the frequency of seizures at 1 month, and this was sustained to 3 months in five patients. Both myoclonic and generalized tonic-clonic seizures were reduced, and two patients became seizure-free.

At a mean follow-up of 13.2 months, four patients remained on the modified Atkins Diet, and no patient had moved to the traditional ketogenic diet.

Side effects of the diet included weight loss in five patients and a transient increase in serum cholesterol in one patient; several patients reported that the diet was difficult to adhere to.

Kossoff and colleagues write: "Dietary therapies offer patients with epilepsy a sense of control of their treatment, which can be empowering for individuals with JME... [and] potentially lead to anticonvulsant medication reduction and reduction of associated adverse effects."

They conclude: "These results suggest that further prospective studies of dietary treatments for JME are warranted, comparing the response to the modified Atkin's Diet in patients with JME versus other medically resistant seizure types and comparing the modified Atkins Diet versus other dietary or medical treatments including quality-of-life assessments."

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