Trial of the Modified Atkins Diet in Infantile Spasms Refractory to Hormonal Therapy

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01549288
Recruitment Status : Withdrawn
First Posted : March 9, 2012
Last Update Posted : April 9, 2013
Information provided by (Responsible Party):
Satinder Aneja, Lady Hardinge Medical College

March 6, 2012
March 9, 2012
April 9, 2013
February 2012
October 2013   (Final data collection date for primary outcome measure)
Proportion of children who achieved spasm freedom as per parental reports at 4 weeks [ Time Frame: 4 weeks ]
Same as current
Complete list of historical versions of study NCT01549288 on Archive Site
Proportion of children who achieved >50% reduction of clinical spasm, as per parental reports at 4 weeks [ Time Frame: 4 weeks ]
Same as current
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Trial of the Modified Atkins Diet in Infantile Spasms Refractory to Hormonal Therapy
Evaluation of the Modified Atkins Diet in Children With Infantile Spasms Refractory to Hormonal Therapy: a Randomized Controlled Trial

Infantile spasms comprise an infantile epileptic encephalopathy characterized by hypsarrhythmia on EEG, and frequent neurodevelopmental regression. Unfortunately the treatment of this disorder remains difficult. The first-line options which include hormonal therapy, i.e., adrenocorticotropic hormone (ACTH) or oral corticosteroids, and vigabatrin are effective in 60-70% of the patients. Hormonal therapy is considered the best available treatment. Vigabatrin being expensive and of limited availability is not a feasible option for most patients in our setting. Also, these are however associated with significant side effects, and high relapse rates. Newer drugs such as topiramate, zonisamide, and levetiracetam have also been evaluated; however these drugs are less effective than ACTH. The ketogenic diet (KD) is a high fat, low carbohydrate diet. It has been used for treatment of intractable childhood epilepsy. The KD has also been shown to be effective for intractable infantile spasms; often after ACTH and vigabatrin have failed.

The modified Atkins diet is a non-pharmacologic therapy for intractable childhood epilepsy that was designed to be a less restrictive alternative to the traditional ketogenic diet. This diet is started on an outpatient basis without a fast, allows unlimited protein and fat, and does not restrict calories or fluids. Preliminary data have shown efficacy in refractory infantile spasms. This diet is also ideal for resource-constraint settings with paucity of trained dieticians. Hence this study has been planned to evaluate the efficacy and tolerability of the modified Atkins diet in children with infantile spasms refractory to hormonal treatment in a randomized controlled trial.

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Phase 2
Phase 3
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Infantile Spasms
  • Behavioral: modified Atkins diet
    Carbohydrate restricted to 10 g/day (18-36 months) and 5 g/day (9-18 months), fat intake encouraged, proteins unrestricted
  • Other: no dietetic input
    continuation of anti-epileptic medication without any dietetic input
  • Experimental: modified Atkins diet
    Intervention: Behavioral: modified Atkins diet
  • control arm
    the control arm continues the anti-epileptic drugs without any added dietetic input
    Intervention: Other: no dietetic input
Not Provided

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
December 2013
October 2013   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  1. age 9 months to 3 years
  2. Presence of epileptic spasms in clusters in child 9 months to < 3years of age, with electroencephalographic evidence of hypsarrhythmia or its variants), persisting, at least one cluster per day, despite treatment with either oral corticosteroids or adrenocorticotrophic hormone (ACTH) and one additional anticonvulsant (valproate/benzodiazepine/vigabatrin/topiramate/zonisamide/ levetiracetam) for at least 4 weeks.

Exclusion Criteria:

  • Children with known or suspected inborn error of metabolism, Patients with clinical suspicion of metabolic disorder as evidenced by 2 or more of the following:

    • a history of parental consanguinity,
    • prior affected siblings,
    • unexplained vomiting,
    • intermittent worsening of symptoms,
    • recurrent episodes of lethargy,
    • altered sensorium, or
    • ataxia,
    • hepatosplenomegaly on examination
  • With or without 2 or more of the following biochemical abnormalities:

    • High blood ammonia (> 80mmol/L),
    • High arterial lactate (> 2 mmol/L),
    • metabolic acidosis (pH < 7.2),
    • hypoglycaemia (blood sugar < 40 mg/dl),
    • abnormal urinary aminoacidogram,
    • presence of reducing sugars or ketones in urine, and
    • positive results on urine neurometabolic screening tests. In such patients, blood tandem mass spectrometry or urine gas chromatography mass spectroscopy (GCMS) will be obtained to look for inborn error of metabolism.
  • Children with renal, pulmonary, cardiac or hepatic dysfunction
  • Severe malnutrition (weight for length and height for age less than 3 SD for mean as per WHO growth charts),
  • Children from families who lack motivation will also be excluded as it might affect the compliance.
Sexes Eligible for Study: All
9 Months to 36 Months   (Child)
Contact information is only displayed when the study is recruiting subjects
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Satinder Aneja, Lady Hardinge Medical College
Lady Hardinge Medical College
Not Provided
Not Provided
Lady Hardinge Medical College
April 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP