Should we routinely use modified Atkins diet instead of regular ketogenic diet to treat children with epilepsy?

The modified Atkins diet (MAD) consists of a nearly balanced diet without any age-dependent restriction of recommended daily calorie intake. Recently, there has been a marked increase in the use of the MAD in the treatment of epilepsy. Over the last 8 years, evidence suggesting that the MAD may exhibit similar anticonvulsant properties as the traditional ketogenic diet (KD) has been accumulating. KD is now an 'evidence-based' treatment for refractory epilepsy. Although there are currently no direct comparisons data from the literature suggest that the KD is more efficacious than the MAD. However, the MAD is easier to administer and has better tolerability. This review discusses when to consider each diet. The MAD may be the first diet of choice. In case of insufficient efficacy under the MAD, a switch from the MAD to the KD should be considered.