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Modified Atkins diet versus topiramate in young children with epileptic spasms refractory to steroids and vigabatrin:
Rashmi Meena1, Sayoni Roy Chowdhury1, Aman Elwadhi2
1Department of Paediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.
Insights
The Modified Atkins Diet (MAD) is more effective than Topiramate for treating infantile epileptic spasms refractory to initial therapies. This dietary intervention showed significant improvements in spasm reduction and alertness.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Nutrition
Background:
- Limited evidence exists for treating infantile epileptic spasm syndrome (IESS) after first-line treatments fail.
- Hormonal therapy and vigabatrin are common first-line treatments for IESS.
Purpose of the Study:
- To compare the efficacy and tolerability of the Modified Atkins Diet (MAD) against Topiramate in children with IESS who did not respond to initial therapies.
- To evaluate spasm frequency, electroencephalographic (EEG) improvements, and non-seizure domain changes.
Main Methods:
- A randomized open-label trial involving 80 children with IESS.
- Participants were randomized to either the Modified Atkins Diet (MAD) or Topiramate.
- Assessments at 12 weeks included spasm frequency, BASED score for EEG, adverse effects, and non-seizure improvements.
Main Results:
- The MAD group showed statistically significant improvements in >50% spasm reduction (67.5% vs. 42.5%) and >90% spasm reduction (22.5% vs. 4.76%) compared to Topiramate.
- MAD also led to greater improvement in the BASED score (40% vs. 12.5%) and alertness (17.5% vs. 2.5%).
- Both treatments were generally well-tolerated with mild side effects.
Conclusions:
- The Modified Atkins Diet (MAD) is a more effective treatment option than Topiramate for refractory infantile epileptic spasms.
- Further research with larger cohorts and extended follow-up is needed to validate these findings.
- ClinicalTrials.gov identifier: NCT05958160.
Background:
There is a paucity of evidence regarding the best treatment options for children with infantile epileptic spasm syndrome who have failed the first-line treatments, i.e. hormonal therapy and/or vigabatrin. The study aimed to compare the efficacy and tolerability of the Modified Atkins Diet (MAD) versus Topiramate in this population.
Methods:
This was a randomized open-label trial that enrolled children with infantile epileptic spasm syndrome who had failed a trial of hormonal therapy and vigabatrin. Patients were randomly assigned to receive either MAD or Topiramate. Both groups were assessed at 12 weeks for spasm frequency through parental records, improvement in electroencephalographic findings as measured by the BASED (Burden of AmplitudeS and Epileptiform Discharges) score, adverse effects, and improvement in non-seizure domains. Intention-to-treat analysis was performed.
Results:
A total of 80 children were recruited, with 40 children each in the MAD and topiramate arms. Children in the MAD arm showed a statistically significant improvement compared to the Topiramate arm at 12 weeks in terms of >50% spasm reduction (27/40, 67.5% vs. 17/40, 42.5%, p- 0.02), >90% spasm reduction (9/40, 22.5% vs. 2/40, 4.76%, p- 0.02), > 1 point improvement in BASED score (16/40, 40% vs. 5/40, 12.5%, p- 0.005), and improvement in alertness (7/40, 17.5% vs. 1/40, 2,5%, p=0.026). Both interventions were well tolerated by the children, with mild side effects, including constipation, diarrhoea, and anorexia in the MAD arm, and anorexia and somnolence in the topiramate arm.
Conclusion:
MAD proved to be more effective than Topiramate in managing epileptic spasms refractory to first-line treatment. However, further studies with larger sample sizes and longer follow-up periods are required to generalize the findings. (ClinicalTrials.gov, NCT05958160).
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