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Ketogenic Diet for New-Onset Absence Epilepsy

Primary Purpose

Absence Epilepsy, Ketogenic Dieting, Epilepsy, Absence

Status
Recruiting
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Modified Atkins Diet
Absence epilepsy medications
Sponsored by
Johns Hopkins University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Absence Epilepsy focused on measuring ketogenic, diet, absence

Eligibility Criteria

3 Years - 12 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Children ages 3-12 years at seizure onset with classic childhood absence epilepsy clinically.
  • Normal intellect or mild disability
  • EEG with confirmed 3/second spike-wave discharges, usually with hyperventilation
  • Daily reported absence seizures.
  • Generalized convulsions allowed

Exclusion Criteria:

  • Previous treatment with any anticonvulsant drug
  • Previous use of a ketogenic dietary therapy for epilepsy or any other condition
  • Glut1 deficiency syndrome
  • Metabolic disorder known that would preclude dietary therapy
  • Dietary restrictions for which a high fat, low carbohydrate diet would be precluded.
  • Prior history of epilepsy (febrile seizures allowed)
  • Unwilling to consent to study procedures or return for visits

Sites / Locations

  • Johns Hopkins HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Diet therapy

Drug therapy

Arm Description

Modified Atkins Diet - high fat, low carbohydrate, outpatient initiated approach. Parents will check urine ketones twice weekly and follow by email, phone and clinic. Labs at baseline and 3 months. Dietitian support.

Families will have the usual care for absence epilepsy at the discretion of the family's neurologist and the family choice. Typically ethosuximide bis in die (BID), however, if convulsions have occurred or other factors are involved, the child may be started on valproate or lamotrigine. The child will continue medications with dose adjustment and antiseizure drug levels checked as usual. **OF NOTE, THIS ARM IS COMPLETED

Outcomes

Primary Outcome Measures

Change in seizure frequency
Parental report of seizure frequency.

Secondary Outcome Measures

Tolerability of diet therapy as assessed by restrictiveness of the diet therapy
Diet therapy restrictiveness will be assessed with an open ended questionnaire that asks "how hard has it been for the child?". Completely subjective with no scale or scoring.
Tolerability of diet therapy as assessed by restrictiveness of the diet therapy
Diet therapy restrictiveness will be assessed with an open ended questionnaire that asks "how hard has it been for the child?". Completely subjective with no scale or scoring.
Duration of diet therapy
Duration of diet therapy in months.
Tolerability of diet therapy as assessed by change in urinary ketones
Urinary ketones in mg/dl will be measured (80-160mg/dl is considered large ketosis).
EEG changes (normalization of the baseline spike-wave bursts)
30 minute routine EEG including hyperventilation to induce seizures, compare 3 months to baseline

Full Information

First Posted
February 14, 2020
Last Updated
August 9, 2023
Sponsor
Johns Hopkins University
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1. Study Identification

Unique Protocol Identification Number
NCT04274179
Brief Title
Ketogenic Diet for New-Onset Absence Epilepsy
Official Title
A Prospective, Case-control Evaluation of Ketogenic Dietary Therapy for New-onset Childhood Absence Epilepsy
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 10, 2020 (Actual)
Primary Completion Date
May 1, 2025 (Anticipated)
Study Completion Date
May 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Johns Hopkins University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The ketogenic diet is a medical therapy for epilepsy that is used nearly predominantly for refractory epilepsy (after 2-3 drugs have been tried and failed). However, there is both published evidence for first-line use (infantile spasms, Glut1 deficiency syndrome) and also anecdotal experience (families choosing to change the child's (or the family' own) diet rather than use anticonvulsant medications). Childhood absence epilepsy (refractory) has been published as being responsive to ketogenic diet therapy by the investigators' group previously. This is a small, prospective, 3 month trial to assess if using a modified Atkins diet is a feasible and effective option for new-onset childhood absence epilepsy. The investigators will compare to a group of children in which the parents have declined and chose to start anticonvulsant medications.
Detailed Description
The ketogenic diet has been in continuous use since 1921 for children and adult with medically-refractory epilepsy. One of the major unanswered questions is whether it would be as effective for children with new-onset epilepsy. Although logically, this would be the case, it remains to be shown in clinical trials. Additionally, it is much easier to take a medication than to change dietary habits and there is doubt whether families would truly wish to try dietary therapy first (or stay on dietary therapy if not effective for a 6 month trial period). There is limited published evidence supporting the use of the ketogenic diet as a first-line therapy for infantile spasms, myoclonic astatic epilepsy, and in some situations where a family member had success and the family wishes to start it first. However, these are relatively rare conditions. The emergence of the modified Atkins diet as an outpatient, quickly-initiated, non-fasting approach since 2003 has changed the concept of dietary therapy towards a much less restrictive, potentially emergent therapy. In this way, using dietary therapy could potentially be started before medications for a willing family. The use of dietary therapy (including the modified Atkins diet) for childhood absence epilepsy goes back decades, but was recently profiled in a review article from the investigators' group. In this publication, 17 studies were identified, and 69% of 133 children with refractory childhood absence epilepsy had a >50% seizure reduction and 34% were seizure-free. At the investigators' center, 21 children as of 2011 had been treated with dietary therapy with 19% seizure-freedom. The question of whether results would be similar (or better) for children with new-onset absence epilepsy was unanswered. The standard treatments for childhood absence epilepsy (ethosuximide, valproate, lamotrigine) are effective in ~50% of children by 16-20 weeks. However, side effects exist and include stomach upset, inattention, mood disturbance, rash, liver function test abnormalities, and fatigue. Families at times do ask about avoiding treatment completely, especially as this epilepsy usually resolves in puberty and convulsions only occur in 20% (most children have brief staring spells only). In addition, families do also ask about "nonpharmacologic" treatment, but to date the investigators have not recommended it due to lack of data. This study will have 20 children in each arm (diet and drug) with ability to crossover. Parents with a child with new-onset absence epilepsy will choose between the two therapies. Visits will be at baseline, 1 month and 3 months. EEG, labs and clinic visits will be paid by the parent's insurance (not free).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Absence Epilepsy, Ketogenic Dieting, Epilepsy, Absence
Keywords
ketogenic, diet, absence

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Two arms (diet and drugs) with ability to cross-over at 1 or 3 months.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Diet therapy
Arm Type
Experimental
Arm Description
Modified Atkins Diet - high fat, low carbohydrate, outpatient initiated approach. Parents will check urine ketones twice weekly and follow by email, phone and clinic. Labs at baseline and 3 months. Dietitian support.
Arm Title
Drug therapy
Arm Type
Active Comparator
Arm Description
Families will have the usual care for absence epilepsy at the discretion of the family's neurologist and the family choice. Typically ethosuximide bis in die (BID), however, if convulsions have occurred or other factors are involved, the child may be started on valproate or lamotrigine. The child will continue medications with dose adjustment and antiseizure drug levels checked as usual. **OF NOTE, THIS ARM IS COMPLETED
Intervention Type
Other
Intervention Name(s)
Modified Atkins Diet
Intervention Description
Low carb (20g/day), high fat, moderate protein diet. Started as an outpatient in clinic.
Intervention Type
Drug
Intervention Name(s)
Absence epilepsy medications
Other Intervention Name(s)
Ethosuximide, valproate or lamotrigine
Intervention Description
At neurologist's discretion. *OF NOTE< THIS ARM IS COMPLETED
Primary Outcome Measure Information:
Title
Change in seizure frequency
Description
Parental report of seizure frequency.
Time Frame
At 1 and 3 months post treatment
Secondary Outcome Measure Information:
Title
Tolerability of diet therapy as assessed by restrictiveness of the diet therapy
Description
Diet therapy restrictiveness will be assessed with an open ended questionnaire that asks "how hard has it been for the child?". Completely subjective with no scale or scoring.
Time Frame
At 3 months
Title
Tolerability of diet therapy as assessed by restrictiveness of the diet therapy
Description
Diet therapy restrictiveness will be assessed with an open ended questionnaire that asks "how hard has it been for the child?". Completely subjective with no scale or scoring.
Time Frame
At 6 months
Title
Duration of diet therapy
Description
Duration of diet therapy in months.
Time Frame
Up to 3 months post treatment
Title
Tolerability of diet therapy as assessed by change in urinary ketones
Description
Urinary ketones in mg/dl will be measured (80-160mg/dl is considered large ketosis).
Time Frame
At 1 and 3 months post treatment
Title
EEG changes (normalization of the baseline spike-wave bursts)
Description
30 minute routine EEG including hyperventilation to induce seizures, compare 3 months to baseline
Time Frame
Baseline and at 3 months post treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Children ages 3-12 years at seizure onset with classic childhood absence epilepsy clinically. Normal intellect or mild disability EEG with confirmed 3/second spike-wave discharges, usually with hyperventilation Daily reported absence seizures. Generalized convulsions allowed Exclusion Criteria: Previous treatment with any anticonvulsant drug Previous use of a ketogenic dietary therapy for epilepsy or any other condition Glut1 deficiency syndrome Metabolic disorder known that would preclude dietary therapy Dietary restrictions for which a high fat, low carbohydrate diet would be precluded. Prior history of epilepsy (febrile seizures allowed) Unwilling to consent to study procedures or return for visits
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Eric H Kossoff, MD
Phone
4109559100
Email
ekossoff@jhmi.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eric H Kossoff, MD
Organizational Affiliation
Johns Hopkins University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Johns Hopkins Hospital
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Eric H Kossoff, MD
Phone
410-955-9100
Email
ekossoff@jhmi.edu
First Name & Middle Initial & Last Name & Degree
Eric H Kossoff, MD
First Name & Middle Initial & Last Name & Degree
Zahava Turner, RD
First Name & Middle Initial & Last Name & Degree
Courtney Haney, RD
First Name & Middle Initial & Last Name & Degree
Eva Catenaccio, MD
First Name & Middle Initial & Last Name & Degree
Danielle DeCampo, MD
First Name & Middle Initial & Last Name & Degree
Rachel Penn, MD
First Name & Middle Initial & Last Name & Degree
Ania Dabrowski, MD
First Name & Middle Initial & Last Name & Degree
Lindsay Schleifer, MD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
20647578
Citation
Groomes LB, Pyzik PL, Turner Z, Dorward JL, Goode VH, Kossoff EH. Do patients with absence epilepsy respond to ketogenic diets? J Child Neurol. 2011 Feb;26(2):160-5. doi: 10.1177/0883073810376443. Epub 2010 Jul 20.
Results Reference
background
PubMed Identifier
18410363
Citation
Kossoff EH, Hedderick EF, Turner Z, Freeman JM. A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms. Epilepsia. 2008 Sep;49(9):1504-9. doi: 10.1111/j.1528-1167.2008.01606.x. Epub 2008 Apr 10.
Results Reference
background

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Ketogenic Diet for New-Onset Absence Epilepsy

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