- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04172311
Modified Atkins Diet Versus Levetiracetam for Refractory Childhood Epilepsy (LEVEMAD)
Modified Atkins Diet Versus Levetiracetam for Refractory Epilepsy in Children: A Randomized Open-Label Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate seizures and by the neurobiologic, cognitive, psychological and social consequences of this condition. Epilepsy is a disabling and common neurological condition which rank 4th in the world's neurological disorder burden, which can be controlled successfully in most of the patients with one or more antiepileptic drugs. But approximately 30% of patients with epilepsy have refractory epilepsy, which is, a failure to respond to adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained relief of seizures.Many severe and catastrophic epilepsies present in children such as West syndrome, Lennox Gastaut syndrome, Dravet syndrome. Uncontrolled epilepsy carries significant risks for the affected child, such as injuries, cognitive and behavioural problems. Epilepsy surgery is a good option but it is expensive and not easily available. Also, many children with refractory epilepsy are not good surgical candidates. Hence there is a need to consider alternative treatments in these children.
The ketogenic diet is an individually calculated and rigidly controlled high-fat, low carbohydrate diet used for the treatment of difficult to control seizures. The ketogenic diet is an effective treatment option for refractory childhood epilepsy however it is very restrictive and difficult to implement in low resource settings. The modified Atkins diet is a less restrictive alternative to the traditional ketogenic diet. This diet is started on an outpatient basis without a fast, and allows unlimited protein and fat. This diet has been shown to be equally effective as the ketogenic diet and a useful option in resource-constraint settings. The modified Atkins diet has been demonstrated to be effective in refractory childhood epilepsy in two randomized controlled trials from India. However, in both these trials the control groups continued their ongoing antiepileptic medication without any new treatment.
Levetiracetam is one of the newer antiepileptic drugs available for treating drug resistant epilepsy. It is a broad-spectrum antiepileptic drug effective in most seizure types. It also has an excellent pharmacokinetics and tolerability profile with no known pharmacokinetic interactions. Use of levetiracetam as an add on drug in refractory childhood epilepsy recently in some published studies has shown good efficacy.
In this study, the efficacy of add-on modified Atkins diet will be compared with add-on Levetiracetam in children with refractory epilepsy in a randomized open label trial. The results will aid clinicians in deciding the treatment options when a child has been diagnosed to have refractory epilepsy.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Contact
- Name: Suvasini Sharma
- Phone Number: 91 9910234344
- Email: sharma.suvasini@gmail.com
Study Contact Backup
- Name: Sharmila B Mukherjee
- Phone Number: 91 9818159699
- Email: theshormi@gmail.com
Study Locations
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Delhi
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New Delhi, Delhi, India, 110018
- Recruiting
- Lady Hardinge Medical College
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Contact:
- Suvasini Sharma, MD DM
- Phone Number: 91 9910234344
- Email: sharma.suvasini@gmail.com
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Contact:
- Sharmila B Mukherjee, MD
- Phone Number: 91 9818158699
- Email: sharma.suvasini@gmail.com
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Seizures persisting more than 3 per week despite the use of at least 2 appropriate anti-epileptic drugs in appropriate doses -
Exclusion Criteria:
- Known or suspected inborn error of metabolism
- Surgically remediable causes of epilepsy such as tumours, cortical dysplasia, mesial temporal lobe epilepsy etc with refractory focal epilepsy.
- Prior use of the ketogenic or modified Atkins diet or levetiracetam.
- Systemic illness- chronic hepatic, renal or pulmonary disease
Prior history of depression or severe behavioural problems.
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Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Modified Atkins Diet
Modified Atkins Diet administration
|
Modified Atkins diet is a type of ketogenic diet which is less restrictive
Other Names:
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Active Comparator: Levetiracetam
Levetiracetam will be started at a dose of 10 mg/kg/day in two divided doses and increased to 20 mg/kg/day after 1 week.
Syrups will be used in children younger than 5 years of age, and tablets will be used in children > 5 years of age.
Further dose titration will be done as per the seizure control, in 10 mg/kg/day increments in 2 weekly intervals, to a maximum of 60mg/kg/day.
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Levetiracetam is a second generation anti-epileptic drug which is broad spectrum and commonly used as add-on in refractory epilepsy
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy in reducing seizures measured by The proportion of responders, i.e., patients who achieve > 50% seizure reduction from the baseline in the modified Atkins diet group at 3 months in comparison to the levetiracetam group.
Time Frame: 3 months
|
The proportion of responders, i.e., patients who achieve > 50% seizure reduction from the baseline in the modified Atkins diet group at 3 months in comparison to the levetiracetam group.
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3 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Treatment emergent adverse effects in both groups
Time Frame: 3 months
|
Tolerability and the adverse effects of the modified Atkins diet and levetiracetam
|
3 months
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- LEVEMAD
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Refractory Childhood Epilepsy
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All India Institute of Medical Sciences, New DelhiCouncil of Scientific and Industrial Research, IndiaCompleted
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University of California, Los AngelesNo longer available
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NaviFUS CorporationTaipei Veterans General Hospital, TaiwanCompletedDrug Resistant Epilepsy | Epilepsy, Drug Resistant | Intractable Epilepsy | Refractory Epilepsy | Drug Refractory Epilepsy | Epilepsy, Drug Refractory | Epilepsy, Intractable | Medication Resistant EpilepsyTaiwan
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Hospices Civils de LyonCompletedBenign Childhood Epilepsy With Centro-temporal Spikes (BCECTS) | Focal Cryptogenic Epilepsy of Childhood | Cryptogenic Epilepsy of ChildhoodFrance
-
Madeline FieldsRecruitingDrug Resistant Epilepsy | Refractory Epilepsy | Medically Refractory EpilepsyUnited States
-
Assistance Publique - Hôpitaux de ParisCompletedChildhood Absence Epilepsy [Pyknolepsy]France
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University of Colorado, DenverColorado Department of Public Health and EnvironmentUnknownEpilepsy, Unspecified, Refractory (Medically)United States
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