Mala ManralAll India Institute of Medical Sciences, India
Title: Modified Atkins Diet for the treatment of persons with Drug-resistant Epilepsy: A Randomized Controlled Trial
Modified Atkins Diet has emerged as an adjuvant therapy in Drug Resistant Epilepsy (DRE). The present study aimed to investigate if MAD along with Standard Drug Therapy (SDT) was indeed more effective than SDT alone in reducing seizure frequency and improving psychological outcomes at 6 months in Adolescents and adults with DRE (non-surgical). A prospective randomized controlled trial was conducted at tertiary care referral centre, in India. Persons with DRE aged 10-55 years attending outpatient epilepsy clinics between August 2015 and April 2019, who had more than two seizures/month despite using at least three appropriate Anti-Seizure Medications (ASMs) at their maximum tolerated doses and had not been on any form of diet therapy for the past one year, were enrolled. Patients were assessed for the eligibility and randomly assigned to receive SDT plus MAD (intervention arm) or SDT alone (control arm). The primary outcome was>50% reduction in seizure- frequency, and the secondary outcomes were Quality of Life (QOL), behaviour, adverse events and rate of withdrawal at six months. Intention to treat analysis was performed. 243 patients were screened for eligibility; 160 patients (80 adults and 80 adolescents) were randomized to either intervention or Control arm. Demographic and clinical characteristics in both groups were comparable at baseline. At six months > 50% seizure reduction was seen in 26.2% in the intervention group versus 2.5 % in the control group (95% CI 13.5-33.9; p<0.001). Improvement in QOL was 52.1±17.6 in the intervention group versus 42.5±16.4 in the control group (mean difference, 9.6; 95%CI 4.3 to 14.9, p<0.001). However, behaviour scores could be performed in 49 patients and improvement was seen in intervention versus control group (65.6±7.9 versus 71.4±8.1, p=0.015) at the end of the study. MAD group demonstrated improvement in all aspects (reduction in seizure-frequency, and behavioural problems) compared to control group at the end of the study.
Mala Manral has 27 years of experience in Clinical Nutrition-patient care teaching and Research at All India Institute of Medical Sciences, New Delhi. Awarded Certificate of Registered Dietician by Registration Board of Indian Dietetic Association in 2012, Received TOP 10 Women Healthcare Leadership Award (Neurologist) from Golden AIM conference and awards for excellence and leadership in healthcare. Certificate course from Asian Institute of Ketogenic Diet therapy. Organized Ketogenic Diet Workshop at AIIMS, New Delhi. Received Excellence award in Nutrition Practice at State level IAPEN INDIA quality Awards (ICNC, 2023) in the field of Clinical Nutrition. Received GOLDEN AIM AWARDS FOR EXCELLENCE AND LEADERSHIP IN HEALTHCARE. Published book Delicious keto Recipes: A guide for Caregiver and chapter on “Introduction to Neurological Disorders”. Attended Global Symposium on Ketogenic Therapies from 17th 21 September 2023 Loews Coronado Bay Resort, San Diego Paper published in NEUROLOGY, 2023- Safety, efficacy and Tolerability of Modified Atkins Diet in Person with Drug-Resistant Epilepsy: A Randomized Controlled Trial Won Excellent poster award at xvii International Conference of clinical chemistry and laboratory medicine held at Kyoto, Japan from 20-25th Oct, 2002 Article published in Neurology India on Ketogenic diet in Epilepsy and IDA Delhi Chapter, Member of International Neurological Ketogenic Society, Indian Epilepsy Society (IES) and many other organizations.