Quality of life and mental health in adults with pharmacoresistant epilepsy submitted to modified atkins diet therapy

Abstract

Background: Epilepsy is a chronic neurological disorder characterized by the occurrence of epileptic seizures, which impact the quality of life of approximately 2% of the Brazilian population. Despite advances in pharmacological treatment, a proportion of patients remains with uncontrolled seizures and is classified as having drug-resistant epilepsy. In this scenario, non-pharmacological interventions become necessary, and dietary therapies represent a viable option. Objective: To evaluate the impact of the ketogenic diet, specifically the Modified Atkins Diet (MAD), on seizure frequency, quality of life, and mental health in adults with pharmacoresistant epilepsy treated in a middle-income country. Methods: This longitudinal, prospective cohort study included adult patients (> 18 years) with pharmacoresistant epilepsy who initiated MAD and were followed for 12 months. Assessments were conducted at baseline (pre-diet) and after 3, 6, and 12 months of treatment. Outcomes comprised quality of life (QOLIE31) and symptoms of anxiety, depression (HADS), inattention, and hyperactivity (ASRS-18), measured using previously validated instruments, as well as seizure frequency. Longitudinal changes were analyzed using linear mixed-effects models, with multiple imputation applied to address missing data and to account for within-subject correlations across repeated measures. Results: A total of 17 patients were included: 9 patients completed a total of 12 months of diet, 6 completed 6 months and 2 completed 3 months. 10 of the patients presented focal to bilateral tonic-clonic seizures, only one had generalized epilepsy. At 12 months of diet, QOLIE-31 scores increased significantly (+ 17.21, p = 0.043; 95% CI = 0.56 to 33.86) and anxiety scores (HAD-A) also presented significant improvement (-4.38, p = 0.01; 95% CI = -7.63 to -1.07). Trends toward improvement were also observed in other mental health measures. Reductions in seizure frequency were noted, although the magnitude of seizure control varied among participants. Conclusion: In adults with pharmacoresistant epilepsy, the Modified Atkins Diet was associated with meaningful improvements in quality of life and mental health, extending beyond seizure reduction alone.