Comparison of the Efficacy, Safety and Compliance of Ketogenic Diet With Modified Atkins Diet and Low Glycemic Index Treatment in Children With Drug-Resistant Epilepsy

Metabolic dietary therapies serve as a multidimensional intervention for the estimated 30% of pediatric patients with epilepsy who remain refractory to standard antiseizure medications. This review evaluates the clinical utility of the classical ketogenic diet (cKD), modified Atkins diet (MAD), and low glycemic index treatment (LGIT), each utilizing a metabolic shift toward ketogenesis to modulate neuronal excitability and neuroinflammation. While the cKD remains the gold standard for achieving high-level seizure reduction and complete seizure freedom, MAD and LGIT provide robust efficacy for achieving ≥50% responder status with significantly improved palatability. LGIT is associated with the most favorable safety profile and highest patient compliance, particularly among adolescents, due to its less restrictive carbohydrate limits and lower incidence of serious gastrointestinal or metabolic adverse events. Recent advancements in precision medicine highlight the critical roles of genetic etiology, such as variants in SLC2A1 or SCN1A, and gut microbiome composition in predicting individual response to these therapies. With a favorable long-term safety profile when appropriately monitored, these metabolic protocols offer a vital non-pharmacological cornerstone for improving the quality of life for children and their caregivers. Further work is necessary to integrate digital health monitoring and personalized microbiome-targeted strategies to optimize dietary maintenance and therapeutic outcomes.