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The primary objective of this trial is to determine whether an oral administration of Phosphatidylserine-Omega3 would significantly improve the clinical symptoms of children suffering from ADHD. Both the behavior and the academic achievements aspects will be evaluated. In addition, we intend to measure side-effects and adverse events and to examine the possible correlation between biochemical and behavioral alterations.
This study is a single-center, double-blind, randomized, placebo-controlled 15-weeks duration trial to assess safety and efficacy of Phosphatidylserine-Omega3 in children diagnosed with ADHD, according to the DSM-IV. Following screening, the subjects will be randomized to one of two treatment groups:Phosphatidylserine-Omega3 or placebo, in a 2:1 manner. This will be followed by an open-label extension, in which Phosphatidylserine-Omega3 will be administered to all eligible participants.
Primary measures of attention and behavior will be evaluated using Conners Rating Scale (CRS) teacher- rating scales. As a secondary endpoint, the attention and behavior will be measured by CRS and strength and difficulties questionnaires (SDQ) parental- and SDQ teacher-rating scales, assessment a continuous performance test (TOVA), and parental Child Health questionnaire (CHQ). Improvement in ADHD symptoms will be evaluated by Clinical Global of Impression - Improvement (CGI-I). Finally, tolerability will be monitored using Barkley Side Effects Rating Scale (SERS) and biochemical parameters, such as fatty acid profile and monoamines metabolites will be assessed as well.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1 | Experimental |
| |
| 2 | Placebo Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Phosphatidylserine-Omega3 | Dietary Supplement | Phosphatidylserine-Omega3 conjugate capsules. Weeks 0-15: 300 mg/day. weeks 16-30: 150 mg/day and a 150 mg/day one year follow-up. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Conners Rating Scale - School Version | A questionnaire that assesses symptoms of ADHD in children and adolescents according to the DSM-IV guidelines. It consists of questions on classroom behavior. Based on the questionnaire results, subscales and global indexes are calculated, including restless-impulsive index, emotional lability index and hyperactive/impulsive subscale. The lowest scale score is 40 (best)and the highest is 90 (worse). Usually, a score below 62 is considered normal and a score above 62 is considered abnormal. | change from baseline in conners raiting scale at 15 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Conners Rating Scale - Home Version | A questionnaire that assesses symptoms of ADHD in children and adolescents according to the DSM-IV guidelines. It consists of questions on the childs home behavior. Based on the questionnaire results, subscales and global indexes are calculated, including restless-impulsive index, emotional lability index and hyperactive/impulsive subscale. The lowest scale score is 40 (best)and the highest is 90 (worse). Usually, a score below 62 is considered normal and a score above 62 is considered abnormal. |
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Inclusion Criteria:
Parental written informed consent.
Having a teacher that is familiar with the child and parent and willing to participate.
Age: 13≥ years ≥6
Gender: male and female
Diagnosis: ADHD diagnosed by:
Teacher-rated Attention-Deficit/ Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) School Version at least 1.5 standard deviations (SD) above the norm for the patient's age and gender, Confirmed assessment by Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL),
Clinical Global Impression of Severity of illness (CGI-S) rating of 4 or higher (moderately ill or worse),
Language: Subjects, parents, and teachers must be able to read, write and speak Hebrew
Normal weight and height according to the Israeli standards
Attending full-time to school.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Abraham Weizman, MD | Head of the Research Department, Geha Mental Health Center, Rabin Medical Center | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| ADHD Unit | Petach-Tiqva | 49100 | Israel |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21807480 | Derived | Manor I, Magen A, Keidar D, Rosen S, Tasker H, Cohen T, Richter Y, Zaaroor-Regev D, Manor Y, Weizman A. The effect of phosphatidylserine containing Omega3 fatty-acids on attention-deficit hyperactivity disorder symptoms in children: a double-blind placebo-controlled trial, followed by an open-label extension. Eur Psychiatry. 2012 Jul;27(5):335-42. doi: 10.1016/j.eurpsy.2011.05.004. Epub 2011 Jul 31. |
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Children at the age of 6-13 years were screened at the "Geha mental health center", Israel, for participation in the study. Recruitment of participants was achieved by vast advertisement in newspapers, internet and in practitioners clinics. Participants enrollment period March 2007 to March 2008
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| ID | Title | Description |
|---|---|---|
| FG000 | PS Omega 3 Conjugate | The daily dosage consisted of 4 capsules of PS-Omega3, providing 300 mg Phosphatidylserine per day. |
| FG001 | Placebo | Double-blind: Cellulose (4 capsules per day). Open-label: PS-omega3 |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Double-blind Phase |
|
| |||||||||||||||||||||
| Open-label Phase |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | PS Omega 3 Conjugate | The daily dosage consisted of 4 capsules of PS-Omega3, providing 300 mg Phosphatidylserine per day. |
| BG001 | Placebo | Double-blind: Cellulose (4 capsules per day). Open-label: PS-omega3 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Conners Rating Scale - School Version | A questionnaire that assesses symptoms of ADHD in children and adolescents according to the DSM-IV guidelines. It consists of questions on classroom behavior. Based on the questionnaire results, subscales and global indexes are calculated, including restless-impulsive index, emotional lability index and hyperactive/impulsive subscale. The lowest scale score is 40 (best)and the highest is 90 (worse). Usually, a score below 62 is considered normal and a score above 62 is considered abnormal. | The analysis includes per-protocol (PP) population. Out of the 162 children who completed the study, 15 children were excluded from PP analysis due to low compliance or protocol violation. | Posted | Mean | Standard Error | Scores on a scale | change from baseline in conners raiting scale at 15 weeks |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | PS Omega 3 Conjugate | The daily dosage consisted of 4 capsules of PS-Omega3, providing 300 mg Phosphatidylserine per day. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abdominal pain | Gastrointestinal disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Yael Richter Ph.D | Enzymotec Ltd | +972 74 7177 177 | 144 | Yaelr@enzymotec.com |
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| ID | Term |
|---|---|
| D001289 | Attention Deficit Disorder with Hyperactivity |
| D007175 | Impulsive Behavior |
| D013035 | Spasm |
| ID | Term |
|---|---|
| D019958 | Attention Deficit and Disruptive Behavior Disorders |
| D065886 | Neurodevelopmental Disorders |
| D001523 | Mental Disorders |
| D001519 | Behavior |
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| Colored cellulose tainted with fishy odor | Other | as arm 1 |
|
| change from baseline in conners raiting scale at 15 weeks |
| Strength and Difficulties Questionnaires - School Version | on weeks 0,15 |
| Strength and Difficulties Questionnaires - Home Version | on weeks 0,15 |
| Clinical Global Impression of Improvement | on weeks 0,15 |
| Test of Variables of Attention (TOVA) | on weeks 0,15 |
| Child Health Questionnaire (CHQ)- Parent-completed Form 50 | on weeks 0,15 |
| Plasma and Red Blood Cells Fatty Acid Profile | on weeks 0,15 |
| Blood Monoamines Metabolism | on week 0, 15 |
| Vital Signs | on weeks 0,15 |
| Essential Fatty Acid (EFA)-Deficiency Symptoms | on weeks 0,15 |
| Barkley Side Effects Rating Scale (SERS) | on weeks 0,15 |
| Complete Blood Counts | on weeks 0,15 |
| Biochemical Parameters in Blood - Liver Functions (SGPT, SGOT, Total Bilirubin), Kidney Functions (BUN, Creatinine), Na, K, Cl, Ca | on weeks 0,15 |
| Lipid Profile (Cholesterol, HDL, Triglycerides) | on weeks 0,15 |
| Poor compliance |
|
| NOT COMPLETED |
|
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Clinical Global Impression of Severity (CGI-S) | The CGI is an observer-rated scale that measures illness severity.The clinician evaluates the patient relative to his past experience with other patients with the same diagnosis.The ratings of CGI-S are: 1 = not ill at all, 2 = a borderline case, 3 = only mildly ill, 4 = moderately ill, 5 = seriously ill and 6 = extremely seriously ill. | Number | Participants |
|
| OG001 | Placebo | Double-blind: Cellulose (4 capsules per day). Open-label: PS-omega3 |
|
|
| Secondary | Conners Rating Scale - Home Version | A questionnaire that assesses symptoms of ADHD in children and adolescents according to the DSM-IV guidelines. It consists of questions on the childs home behavior. Based on the questionnaire results, subscales and global indexes are calculated, including restless-impulsive index, emotional lability index and hyperactive/impulsive subscale. The lowest scale score is 40 (best)and the highest is 90 (worse). Usually, a score below 62 is considered normal and a score above 62 is considered abnormal. | The analysis includes per-protocol (PP) population. Out of the 162 children who completed the study, 15 children were excluded from PP analysis due to low compliance or protocol violation. | Posted | Mean | Standard Error | Scores on a scale | change from baseline in conners raiting scale at 15 weeks |
|
|
|
| Secondary | Strength and Difficulties Questionnaires - School Version | Not Posted | on weeks 0,15 |
| Secondary | Strength and Difficulties Questionnaires - Home Version | Not Posted | on weeks 0,15 |
| Secondary | Clinical Global Impression of Improvement | Not Posted | on weeks 0,15 |
| Secondary | Test of Variables of Attention (TOVA) | Not Posted | on weeks 0,15 |
| Secondary | Child Health Questionnaire (CHQ)- Parent-completed Form 50 | Not Posted | on weeks 0,15 |
| Secondary | Plasma and Red Blood Cells Fatty Acid Profile | Not Posted | on weeks 0,15 |
| Secondary | Blood Monoamines Metabolism | Not Posted | on week 0, 15 |
| Secondary | Vital Signs | Not Posted | on weeks 0,15 |
| Secondary | Essential Fatty Acid (EFA)-Deficiency Symptoms | Not Posted | on weeks 0,15 |
| Secondary | Barkley Side Effects Rating Scale (SERS) | Not Posted | on weeks 0,15 |
| Secondary | Complete Blood Counts | Not Posted | on weeks 0,15 |
| Secondary | Biochemical Parameters in Blood - Liver Functions (SGPT, SGOT, Total Bilirubin), Kidney Functions (BUN, Creatinine), Na, K, Cl, Ca | Not Posted | on weeks 0,15 |
| Secondary | Lipid Profile (Cholesterol, HDL, Triglycerides) | Not Posted | on weeks 0,15 |
| 0 |
| 137 |
| 6 |
| 137 |
| EG001 | Placebo | Double-blind: Cellulose (4 capsules per day). Open-label: PS-omega3 | 0 | 63 | 1 | 63 |
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| D020879 | Neuromuscular Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| DSM-IV: Hperactivity impulsivity |
|