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Three above methods of accouterment ketogenic diet assay bargain seizures in accouchement with drug-resistant epilepsy, the randomized DIET balloon showed.
Median abridgement in access accountability was agnate with the ketogenic diet, the adapted Atkins diet, and the low glycemic basis assay diet, admitting neither the adapted Atkins nor low glycemic basis assay diet met belief for non-inferiority to the ketogenic diet, appear Sheffali Gulati, MD, of All India Institute of Medical Science in New Delhi, and co-authors, in JAMA Pediatrics.
Most assay in the accomplished has focused on the ketogenic diet, Gulati noted. “The ketogenic diet is a high-fat diet, and some families and patients acquisition it arduous to attach to and additionally acquaintance austere adverse effects,” she and aboriginal columnist Vishal Sondhi, DM, additionally of All India Institute, said in an email to MedPage Today.
DIET was the aboriginal balloon to analyze the three primary comestible therapies, Gulati and Sondhi added. “The access accountability decreased by greater than 50% in 67% of patients accepting the ketogenic diet, 52% of patients accepting the adapted Atkins diet, and 59% of patients accepting the low glycemic basis assay diet,” they wrote. “Hence, clinicians accept two added modalities in their armamentarium — the adapted Atkins and low glycemic basis assay diets — back they are managing accouchement with drug-resistant epilepsy.”
While the low glycemic basis and adapted Atkins diets “were hardly beneath acceptable to assignment in this study, the low glycemic basis assay had beneath ancillary effects,” acclaimed co-author Eric Kossoff, MD, of Johns Hopkins University in Baltimore.
“The important bulletin is that parents, patients and centers should abide to accomplish abundant decisions apropos which of the three above diets to use,” he told MedPage Today. “They are altered and accept altered pros and cons.”
The balloon included accouchement ages 1 to 15 who had four or added seizures a month, had not responded to two or added anti-seizure drugs, and had not been advised ahead with one of the three diets. Patients were enrolled amid April 2016 and August 2017 at a tertiary affliction barometer centermost in India and were about assigned to accept one of the diets in accession to their advancing anti-seizure drugs.
A absolute of 158 accouchement completed the trial: 52 in the ketogenic diet group, 52 in the adapted Atkins diet, and 54 in the low glycemic basis assay diet. Diets were supplemented with vitamins and minerals, and anniversary patient’s caregiver kept a circadian log of meals, access frequency, urinary ketones, and comestible bent symptoms.
A bit-by-bit nonfasting agreement was acclimated to alpha the ketogenic diet. The adapted Atkins diet accumulation followed the Johns Hopkins protocol. The low glycemic basis diet belted foods with a glycemic basis college than 55 and bound carbohydrates to about 10% of circadian calories. While the adapted Atkins and low glycemic basis diets were started in outpatient settings, accouchement were accepted to alpha the ketogenic plan.
The primary aftereffect was allotment change in access abundance afterwards 24 weeks in the ketogenic diet accumulation compared with anniversary of the others. The balloon had a predefined, noninferiority allowance of −15 allotment points.
After 24 weeks, intention-to-treat assay showed that the average change in access abundance was −66% in the ketogenic diet group, −45% in the adapted Atkins group, and −54% in the low glycemic basis assay accumulation (P = 0.39).
The average aberration in access abridgement amid the ketogenic and adapted Atkins groups was −21 allotment credibility (95% CI −29 to −3 allotment points). Amid the ketogenic and low glycemic basis assay groups, it was −12 allotment credibility (95% CI −21 to 7 allotment points). Neither diet met noninferiority criteria.
Treatment-related adverse contest were agnate in the ketogenic (31 of 55; 56.4%) and adapted Atkins groups (33 of 58; 56.9%), but were decidedly beneath in the low glycemic basis accumulation (19 of 57; 33.3%).
The best accepted analytic adverse accident was vomiting. Two patients on the low glycemic basis diet and one on the ketogenic diet had thrombocytopenia at 24 weeks; both were accepting sodium valproate (Depakote). Ten patients, all accepting accessory zonisamide (Zonegran), had hypercalciuria at 24 weeks. Two patients on the adapted Atkins diet developed scurvy. Three patients developed a abiding QTc interval.
“The accident profiling illustrated that the low glycemic basis assay diet was associated with the atomic cardinal of and atomic astringent adverse events, while the added two diets were added acceptable to be associated with astringent and life-threatening events,” Gulati and Sondhi noted.
The abstraction had blinding limitations because the diets appropriate abutting affectionate interaction. Circadian logs ability accept absent some seizures and may accommodate abstract errors. This was a single-center abstraction and alternative bent may accept occurred.
Judy George covers neurology and neuroscience account for MedPage Today, autograph about academician aging, Alzheimer’s, dementia, MS, attenuate diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow
Kossoff appear accepting abutment from Nutricia alfresco the submitted work. No added disclosures were reported.
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