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Short-Term Efficacy and Safety of Dietary Therapies In Children With Drug-Resistant Epilepsy: A Network Meta-Analysis

Objective: To assess the short-term comparative efficacy and safety of different dietary therapies in childhood DRE. Methods: A systematic literature search of PubMed and Embase (till January 2022) was done. Randomized controlled trials(RCTs) comparing different dietary therapies [Ketogenic diet(KD), modified Atkins diet(MAD), low glycemic index therapy(LGIT)], and care as usual(CAU) were included. Short-term (3 months) ≥50% reduction in seizure frequency, seizure freedom, and adverse event(AE)-related treatment withdrawal were the primary efficacy and safety outcomes. A network meta-analysis was done and the hierarchy of competing interventions was defined using the surface under the cumulative ranking curve. Results: Twelve RCTs with 907 participants were evaluated. As compared with CAU, a statistically significant number of participants achieved ≥50% seizure reduction [LGIT(OR:24.7; 95% CI:5.3-115.4), MAD(OR:11.3; 95% CI:5.1-25.1), KD(OR:8.6; 95% CI:3.7- 20.0)] and seizure freedom [KD (OR:5.0; 95% CI:1.3-19.5), MAD (OR:4.4; 95% CI:1.3-14.5), LGIT (OR:1.8; 95% CI:0.2-14.3)] with different dietary therapies. LGIT(0.92) and KD (0.81) had the highest ranking probability for achieving ≥50% seizure reduction and seizure freedom respectively. During the treatment period, the dietary therapies like KD (OR: 9.5; 95% CI: 2.0-45.3) and MAD (OR: 5.8; 95% CI: 1.2-28.1) had to be withdrawn for 44/633 (7%) participants due to AEs as compared with CAU. However, on indirect comparison, there was no significant difference for safety outcomes. Conclusion: KD, MAD, and LGIT are efficacious in short-term as compared with CAU. Although KD followed by MAD had the highest probability for seizure freedom, future head-to-head trials comparing different dietary therapies are the need of the hour.

Priyanka Madaan
Post graduate Institute of Medical Education and Research, Chandigarh, India
India

Nagita Devi
National Institute of Pharmaceutical Education and Research, Mohali
India

Dipika Bansal
National Institute of Pharmaceutical Education and Research, Mohali
India

Jitendra Sahu
Post graduate Institute of Medical Education and Research, Chandigarh, India
India

 


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