Comparison of Efficacy of LGIT and MAD Among Children With Drug Resistant Epilepsy

Comparison of Efficacy of Low Glycemic Index Therapy and Modified Atkins Diet Among Children With Drug Resistant Epilepsy: A Randomized Non-inferiority Trial

To compare the efficacy of two less restrictive dietary therapies - LGIT and MAD, used for treatment of drug resistant epilepsy in children

Study Overview

• Status: Unknown
• Conditions: Drug Resistant Epilepsy; Ketogenic Dieting
• Intervention / Treatment: Other: Low glycemic Index Therapy (LGIT); Other: Modified Atkins Diet (MAD)

Detailed Description

Up to one third of patients with epilepsy progress to drug resistant epilepsy (DRE). Current treatment options for DRE include epileptic surgery and dietary therapy. Classic KD (Ketogenic diet) is the most studied dietary therapy but the stringent restrictions and practical difficulty makes it difficult to follow. So less restrictive diets like MAD and LGIT were introduced. These are reported to have less adverse effects also. But no published study has ever been conducted comparing these two diets head to head.

• Study Type: Interventional
• Enrollment (Anticipated): 110
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Sheffali Gulati, MD; Phone Number: 9810386847; Email: sheffaligulati@gmail.com
• Study Contact Backup: Name: Vaishakh Anand, MD; Phone Number: 7838528549; Email: drvyshakhanandmp@gmail.com

Study Locations

• India
  • Delhi
    • New Delhi, Delhi, India, 110029
      • Recruiting
      • All India Institute of Medical Sciences
    • New Delhi, Delhi, India
      • Recruiting
      • AIIMS
      • Contact: Sheffali Gulati, M.D.; Phone Number: 011 26594679; Email: sheffaligulati@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 4 months to 13 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Children aged 1-15 years with drug resistant epilepsy
• Willing to come for regular follow-up according to study protocol Drug resistant epilepsy defined as
• Seizure frequency >4 seizures per month, while on optimal doses of at least 2 prescribed antiepileptic drugs
• For West syndrome, drug resistant epilepsy will be defined as more than 4 clusters of spasms per month despite treatment with antiepileptic drugs and either ACTH(Adrenocorticotrophic hormone) or Vigabatrin

Exclusion Criteria:

• Surgically remediable causes for DRE
• Inborn errors of metabolism
• Previously received KD, MAD or LGIT

• Known case of

  1. Chronic kidney disease
  2. Chronic liver disease/GI illness
  3. Congenital/acquired heart disease
  4. Chronic respiratory illness

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Low Glycemic Index therapy; Specific dietary therapy called Low glycemic Index Therapy (LGIT) which provides diet including food items with glycemic index less than 50 only	Other: Low glycemic Index Therapy (LGIT); Specific dietary therapy called Low glycemic Index Therapy (LGIT) which provides diet including food items with glycemic index less than 50 only. For this purpose, various dietary menus will be provided to the parents.
Active Comparator: Modified Atkins Diet; Specific dietary therapy called Modified Atkins Diet (MAD) which provides diet with restricted carbohydrates upto 20 grams per day and increased fat and protein ratio	Other: Modified Atkins Diet (MAD); Specific dietary therapy called Modified Atkins Diet (MAD) which provides diet with restricted carbohydrates upto 20 grams per day and increased fat and protein ratio. For this purpose, various dietary menus will be provided to the parents.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of seizure reduction from baseline at 24 weeks of therapy	Mean weekly seizure reduction at 24 weeks divided by Mean weekly seizure measured at baseline multiplied by 100	At the end of 24 weeks of dietary therapy

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of children who achieve >50% seizure reduction	Number of children with >50% reduction divided by number of children in each arm	At the end of 24 weeks of dietary therapy
Incidence of adverse events	Routine hemogram, Renal function test (RFT), Liver function test (LFT) and lipid profile will be assessed for any alterations. Adverse events, vomiting, constipation and diarrhea will be checked by parents record	At the end of 24 weeks of dietary therapy
Compliance of participants with dietary therapy in each arm will be determined each week, whether satisfactory or unsatisfactory	Weekly compliance assessment of each participant will be done	At the end of 24 weeks of dietary therapy
Change in Social quotient(SQ) with each dietary therapies	Proportion of children with improvement in Social quotient (SQ) assessed by Vineland Social Maturity Scale (VSMS) at 24 weeks. VSMS consists of 8 subsets - Communication skills, General self-help ability, Locomotion skills, Occupation skills, Self-direction, Self-help eating, Self-help dressing, Socialization skills. Social age is calculated by adding the scores of all subsets. Social quotient (SQ) is calculated by social age divided by chronological age multiplied by 100.	At the end of 24 weeks of dietary therapy
Change in Quality of Life of participants who are less than 4 years of age at 24 weeks as compared to baseline	In children less than 4 years quality of life is assessed by PedsQL (Pediatric Quality of life inventory). PedsQL consists of 21 questions each having 5 responses with scores 0,1,2,3 and 4. Minimum score is 0 and maximum is 84. Quality of life is poor with larger score.	At the end of 24 weeks of dietary therapy
Change in Quality of Life of participants who are more than or equal to 4 years of age at 24 weeks as compared to baseline	In children with age 4 years or more, QOLCE 55 (Quality of life in childhood epilepsy questionnaire) is used to assess quality of life. QOLCE 55 consists of 55 questions which are classified into 4 categories. Each question have 5 responses with scores as 0,25,50,75 and 100. Mean score of each category is calculated and final score calculated by mean of the scores of 4 categories. Minimum score is 0 and maximum is 100. Quality of life is better with larger score.	At the end of 24 weeks of dietary therapy
Change in Quality of Life of caregivers at 24 weeks as compared to baseline	Quality of life of caregivers is assessed by WHOQOL-BREF. WHOQOL BREF contains 26 items categorized into 4 domains. For each question response is scored 1,2,3,4 or 5. Total raw score is then calculated and is converted to transformed score. Minimum score is 0 and maximum is 100. Quality of life is poor with smaller score.	At the end of 24 weeks of dietary therapy
Gut microbiota (GM) analysis pre and post dietary therapy	Changes in percentage distribution of various micro organisms in gut microbiota after dietary therapy as compared to baseline GM	At the end of 24 weeks of dietary therapy
Change in behavioral abnormalities with each dietary therapy	Behavior assessment is done using Child behavior check list (CBCL).This questionnaire contains 100 and 113 questions for age groups of 1 ½ - 5 years and 6-18 years respectively. Score of 2 will be given for a response of 'very true', 1 for a response of 'somewhat true' and 0 for 'not true'. Total score is obtained by adding all the subsets. Subsets for age 1.5 years to 5 years include - Emotionally reactive, anxious/depressed, somatic complaints, withdrawn, sleep problems, attention problems, aggressive behavior and other problems. Subsets for age 6 years to 12 years include - Anxious/Depressed, withdrawn, somatic complaints, social problems, thought problems, attention problems, rule breaking behavior, aggressive behavior, other problems. Raw score is then converted to T score according to the published charts. Minimum T score is 28 and maximum is 100. Larger score indicates more behavioral problems.	At the end of 24 weeks of dietary therapy

Collaborators and Investigators

• Sponsor: All India Institute of Medical Sciences, New Delhi
• Investigators: Principal Investigator: Sheffali Gulati, MD, All India Institute of Medical Sciences, New Delhi

Study record dates

Study Major Dates

• Study Start (Actual): December 26, 2018
• Primary Completion (Anticipated): December 1, 2019
• Study Completion (Anticipated): December 1, 2019

Study Registration Dates

• First Submitted: November 4, 2018
• First Submitted That Met QC Criteria: December 4, 2018
• First Posted (Actual): December 5, 2018

Study Record Updates

• Last Update Posted (Actual): September 10, 2019
• Last Update Submitted That Met QC Criteria: September 9, 2019
• Last Verified: September 1, 2019

More Information

Terms related to this study

• Keywords: MAD; LGIT
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Epilepsy; Drug Resistant Epilepsy
• Other Study ID Numbers: IECPG/504/10/2018

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No