Safety and Efficacy of Modified Carbohydrate Diet (mcd) In Children With Drug-Resistant Epilepsy: Proof-of-Concept Study

Introduction: In regions where carbohydrate-rich diets are culturally preferred, implementing traditional low-carbohydrate diets for children with drug-resistant epilepsy poses significant challenges. This study aimed to assess the safety and efficacy of the Modified Carbohydrate Diet (MCD) as an alternative treatment that primarily focuses on the quality of carbohydrates without absolutely restricting them.

Methods: A retrospective chart review was conducted comprising children aged 0-18 years enrolled in our hospital's MCD program for drug-resistant epilepsy and availing outpatient or inpatient services between January 2012 and November 2022 out of which children adhering to the MCD for at least three months after initiation were included in this study.

Results: Of 227 children screened, 97 children were included with a median follow-up of 6.4 (1.2-21.3) years. The median age at MCD initiation was 3.8 years, with 48.4% having a genetic or unknown epilepsy diagnosis. Forty-nine children had a baseline seizure frequency exceeding four seizures per day. The MCD was administered in two steps, with 83.5% beginning with Step 1 (sugar restriction) and 16.5% with Step 2 (rice, roots, and tuber restriction). The median diet duration was 14 months. At the last contact, 69% reported a seizure reduction of more than 50%, with 71% continuing the diet for over 12 months. Adverse events were reported in 9.3% of cases without any mortality.

Conclusion: The study indicates that MCD effectively reduces seizures in children with drug-resistant epilepsy with minimal adverse events. However, further large-scale studies are needed to explore this novel dietary approach.

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