Modified Atkins diet therapy in adult drug‐resistant epilepsy: Quality of life and mental health outcomes

OBJECTIVE: This study aims to assess the effect of ketogenic diet therapy on seizure frequency, quality of life, and mental health symptoms in adults with drug-resistant epilepsy (DRE). METHODS: We conducted a longitudinal, quantitative, prospective, and single-center cohort study. Patients were recruited from a tertiary health care center in Brazil. The modified Atkins diet was prescribed to adult (≥18 years old) patients with DRE. Patients were accompanied closely by a specialized team of doctors and nutritionists, with a nutritionist available 24/7. Blood ketone levels were measured using a β-hydroxybutyrate meter and corresponding test strips. Patients were instructed to record all events in a seizure diary and completed questionnaires (Quality of Life in Epilepsy Inventory 31 [QOLIE-31], Hospital Anxiety and Depression Scale [HADS], and Adult Self-Report Scale [ASRS]) during the follow-up period to evaluate mental health and quality of life. Joint multiple imputation was used to address missing data, and statistical analysis was performed with linear mixed models. RESULTS: A total of 17 patients were included, of whom nine were followed up for a total of 12 months and six for 6 months, and two completed 3 months of diet. Ten of the patients presented with focal to bilateral tonic-clonic seizures, and only one had generalized epilepsy. At 12 months of diet, QOLIE-31 scores increased significantly (+17.21, p = .043, 95% confidence interval [CI] = .56-33.86), and anxiety scores (HADS-A) also showed a significant improvement (-4.38, p = .01, 95% CI = -7.63 to -1.07). No significant changes were observed in seizure frequency or ASRS. SIGNIFICANCE: In this single-arm prospective cohort study, modified Atkins diet therapy was associated with improved quality of life and reduced anxiety symptoms in adults with DRE, independent of major changes in seizure frequency.