Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 16 2 2017 04 19 72 77 EN Mohammad Zare Isfahan Neurosciences Research Center, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran Ali Asghar Okhovat Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Ahmad Esmaillzadeh Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran Jafar Mehvari Isfahan Neurosciences Research Center, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Reza Najafi Isfahan Neurosciences Research Center, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Saadatnia Isfahan Neurosciences Research Center, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran 2016 02 15 2017 04 13 Background: The usefulness of the modified Atkins diet (mAD) in refractory epilepsy in adults has been rarely investigated. We aimed to evaluate the efficacy of mAD in adult with refractory epilepsy. Methods: In a controlled randomized clinical trial, we enrolled 66 refractory adult epileptic cases from February 2010 to December 2012. The patients were randomly divided into two groups, case groups (22 patients) used antiepileptic drugs and mAD and control group (32 patients) only use antiepileptic drugs. The primary outcome was at least 50% decrement in seizure frequency after 2 months of therapy. Results: No significant difference was shown in our data between groups regarding baseline characteristic. The differences of mean seizure attack after 2 months (P < 0.001). 6 (17.6%) had > 50% seizure decrease at 1 and after 2 months and 12 (35.3%) had 50% decrease in seizure frequency. Furthermore, in mAD group, the mean urinary ketone positivity was 1.75 ± 0.28 and increasing liver enzyme was shown 5 cases (14.7%) in mAD group and 5 cases (15.6%) in control group (P < 0.050). Conclusion: The mAD may be effective as a cotherapy treatment for adults with refractory epilepsy and decrease 2.19 times seizure frequency in comparison with control groups. Trials with the more tolerant dietary regime, with larger sample size and longer duration, should be performed in future. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/993 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/993/330