Abstracts

Rationale: Juvenile myoclonic epilepsy (JME) is often successfully treated with anticonvulsants; however some cases may be medically resistant. The modified Atkins diet (MAD) has been reported as effective for idiopathic generalized epilepsy (absence) and is increasingly being selected for use in adolescents and adults over the ketogenic diet due to the greater flexibility in its administration. We reviewed our experience in using the MAD for JME. Methods: Since 2006, eight adolescents and adults were started on the MAD for JME at the Johns Hopkins Hospital. Six patients were followed prospectively and records were retrospectively reviewed for two patients to ascertain efficacy, diet duration, and adverse effects. Results: Of these 8 patients, 6 (75%) were female, with a mean age of seizure onset of 10.5 years (range: 6-13 years) and MAD initiation at 24.3 years (range: 15-44 years). Patients had tried a mean of 5.4 anticonvulsants before dietary therapy with the exception of a 15-year-old female who attempted the MAD as first-line therapy. Seven achieved at least moderate ketosis; the mean diet duration to date is 11.2 months (range: 0.5-36 months). After 1 month, 6/8 (75%) had >50% seizure reduction and after 3 months, 5/8 (63%) had >50% improvement. Two patients became seizure-free for extended periods on MAD. Five reported reduction in both myoclonic and generalized tonic-clonic seizure frequency. Side effects included weight loss in 5 patients and a temporary increase in cholesterol in one. Most patients found the MAD difficult to adhere to, with 3 reporting temporarily increased seizures during periods of noncompliance. Conclusions: In this limited experience, the modified Atkins diet was efficacious adjunctive therapy for young adults with typically very medically resistant juvenile myoclonic epilepsy, as long as patients remained motivated and compliant. It may be also helpful for patients with juvenile myoclonic epilepsy and comorbid obesity and females who wish to avoid valproate. Prospective clinical trials are warranted.