Modified Atkins Diet therapy during pregnancy for refractory idiopathic generalized epilepsy

The management of refractory epilepsy in pregnancy is challenging, and diet therapy has been rarely reported. We report a case of a 25-year-old woman with refractory idiopathic generalized epilepsy who achieved prolonged seizure freedom with the Modified Atkins Diet (MAD) during pregnancy. Her epilepsy began at age 3, with seizures occurring every two months despite multiple antiseizure medications and vagus nerve stimulation. Three months before her first pregnancy, MAD was initiated with a carbohydrate limit of 30 g daily, resulting in immediate seizure freedom. During the pregnancy, carbohydrate intake was gradually increased to 60-70 g daily to support fetal growth. She remained seizure-free for 10 months before experiencing breakthrough seizures in the third trimester. Oligohydramnios was subsequently detected, and she underwent induction of labor with vaginal delivery at 37 weeks. After delivery, she discontinued MAD for breastfeeding and remained seizure-free for 13 months. In her second pregnancy without MAD, she experienced two breakthrough seizures in the second trimester. She later achieved 23 months of seizure freedom. Both children have met developmental milestones appropriately. This case adds to the limited literature on diet therapy in pregnancy and is, to our knowledge, the first involving generalized epilepsy. The case suggests MAD may provide seizure control during pregnancy, even with possible sustained benefit after discontinuation. However, given the occurrence of oligohydramnios and limited safety data, larger studies are needed to clarify the efficacy, safety, and long-term outcomes of diet therapy during pregnancy.