Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis

Abstract

Background and purpose: Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice.

Methods: Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies of the efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy; the included studies were reviewed. Meta-analyses were performed using STATA to determine combined efficacy rates and combined rates of compliance with the ketogenic diet and its main subtypes.

Results: In total, 12 studies qualified for inclusion, and data from 270 patients were evaluated.The results of the meta-analysis revealed combined efficacy rates of all types of ketogenic diet, a classical ketogenic diet, and a modified Atkins diet were 42%, 52%, and 34%, respectively; the corresponding combined compliance rates were 45%, 38%, and 56%.

Conclusions: The results indicate that a ketogenic diet is a promising complementary therapy in adult intractable epilepsy, and that while a classical ketogenic diet may be more effective, adult patients are likely to be less compliant with it than with a modified Atkins diet.

Keywords: adult; compliance; efficacy; intractable epilepsy; ketogenic diet.

Fig. 1

Flowchart of studies included and excluded. KD: ketogenic diet.

Fig. 2

The forest and funnel plots of the combined efficacy rates of ketogenic diet and its variants. CI: confidence interval, CKD: classical ketogenic diet, MAD: modified Atkins diet, MCT: medium-chain triglycerides diet, N: number of total subjects, n: number of patients achieving success in total subjects, % weight: percentage that each study counts in the results of the meta-analysis.

Fig. 3

The forest and funnel plots of the combined compliance rates of ketogenic diet and its variants. CI: confidence interval, CKD: classical ketogenic diet, MAD: modified Atkins diet, MCT: medium-chain triglycerides diet, % weight: percentage that each study counts in the results of the meta-analysis.