Seizure. 2026 Jan 24;135:77-87. doi: 10.1016/j.seizure.2026.01.014. Online ahead of print.

ABSTRACT

OBJECTIVES: Epilepsy is a common neurological disorder that can severely affect children’s cognitive development and quality of life. While anti-seizure medications (ASM) are the first-line treatment, approximately 20-30% of pediatric patients experience drug-resistant epilepsy (DRE), necessitating alternative therapies. The classical ketogenic diet (CKD) and the modified Atkins diet (MAD) are two non-pharmacological interventions that have shown efficacy in reducing seizure frequency in children with DRE.

METHODS: A meta-analysis included experimental and observational studies retrieved from relevant databases. It evaluated the efficacy of CKD and MAD in children with DRE. Data were extracted and analyzed using RevMan. A 3-month follow-up was used to measure all outcomes, whenever available; otherwise, the nearest reported time point was used.

RESULTS: Eight studies were included in this meta-analysis. Both MAD and CKD were effective in treating drug-resistant epilepsy. CKD demonstrated a statistically significant advantage over MAD for achieving >50% seizure reduction (OR = 0.55, 95% CI: 0.35-0.87; P = 0.01). However, no statistically significant differences were observed between CKD and MAD for complete seizure freedom (100% reduction; OR = 0.72, 95% CI: 0.43-1.19) or >90% seizure reduction (OR = 0.87, 95% CI: 0.51-1.47). No statistically significant differences were found in lipid-related adverse effects or gastrointestinal symptoms, although MAD showed non-significant trends toward fewer cases of vomiting and constipation.

CONCLUSION: The CKD provides significant advantages in the management of drug-resistant epilepsy over the MAD, and CKD is more effective in reducing seizures at different levels.

PMID:41616756 | DOI:10.1016/j.seizure.2026.01.014

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