Sharawat Indar Kumar, Panda Pragnya, Dawman Lesa, Gupta Diksha, Panda Prateek Kumar
Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Department of Neurology, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, 229405, India.
Seizure. 2025 Sep;131:471-479. doi: 10.1016/j.seizure.2024.12.001. Epub 2024 Dec 4.
Both the Modified Atkins Diet (MAD) and Low Glycemic Index Treatment(LGIT) are considered less restrictive than the ketogenic diet and effective in children with drug-resistant epilepsy(DRE). Several randomized controlled trials (RCTs) have compared these two diets.
All RCTs directly comparing MAD and LGIT for DRE were included in the review. We pooled estimates for percentage seizure frequency reduction, the number of participants with seizure freedom, ≥90 % and ≥50 % reduction in seizure frequency, as well as changes in cognition, behavior, and adverse effects in both groups.
Three RCTs with 265 participants were included. The pooled estimates for the number of children achieving seizure freedom, ≥50 %, and ≥90 % reduction in seizure frequency post-intervention, as well as weekly percentage seizure frequency reduction, were comparable between the MAD and LGIT groups(RR: 1.24 [95 % CI: 0.71-2.16]; I²=0 %, p = 0.45, RR: 0.86 [95 % CI: 0.57-1.29]; I²=62 %, p = 0.45, RR: 1.35 [95 % CI: 0.82-2.21]; I²=5 %, p = 0.24, and MD:6.5 [95 % CI:13.8 to 0.6]; I²=45 %, p = 0.07). The number of children showing improvement in cognition and changes in behavioral comorbidities were also comparable between the groups(p = 0.60 and 0.21). However, the MAD group had a higher incidence of adverse effects(RR: 1.37 [95 % CI: 1.12-1.68]; I²=42 %, p = 0.002), though the number of participants experiencing serious adverse effects was similar in both groups(RR: 1.68 [95 % CI: 0.71-3.99]; I²=0 %, p = 0.24). Adherence rates to the allocated intervention were numerically higher in the LGIT group(p = 0.73).
Both MAD and LGIT are comparable in efficacy, but LGIT is associated with fewer adverse effects.
改良阿特金斯饮食（MAD）和低血糖指数疗法（LGIT）都被认为比生酮饮食限制更少，且对耐药性癫痫（DRE）患儿有效。多项随机对照试验（RCT）对这两种饮食进行了比较。
本综述纳入了所有直接比较MAD和LGIT治疗DRE的RCT。我们汇总了两组癫痫发作频率降低百分比、无癫痫发作参与者数量、癫痫发作频率降低≥90%和≥50%的参与者数量，以及认知、行为和不良反应变化的估计值。
纳入了三项RCT，共265名参与者。干预后达到无癫痫发作、癫痫发作频率降低≥50%和≥90%的儿童数量，以及每周癫痫发作频率降低百分比的汇总估计值，在MAD组和LGIT组之间具有可比性（RR：1.24[95%CI：0.71 - 2.16]；I² = 0%，p = 0.45，RR：0.86[95%CI：0.57 - 1.29]；I² = 62%，p = 0.45，RR：1.35[95%CI：0.82 - 2.21]；I² = 5%，p = 0.24，以及MD：6.5[95%CI：13.8至0.6]；I² = 45%，p = 0.07）。两组中认知改善和行为共病变化的儿童数量也具有可比性（p = 0.60和0.21）。然而，MAD组的不良反应发生率更高（RR：1.37[95%CI：1.12 - 1.68]；I² = 42%，p = 0.002），尽管两组中经历严重不良反应的参与者数量相似（RR：1.68[95%CI：0.71 - 3.99]；I² = 0%，p = 0.24）。LGIT组对分配干预的依从率在数值上更高（p = 0.73）。
MAD和LGIT在疗效上具有可比性，但LGIT的不良反应较少。
