Efficacy of Fluoxetine Against Seizure-induced Central Apneas

NCT ID: NCT02569970

Last Updated: 2016-10-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 70 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2010-11-30
• Study Completion Date: 2015-01-31

Brief Summary

Sudden unexpected death in epilepsy (SUDEP) is a tragic outcome of seizure disorders that primarily affect young adults suffering from refractory epilepsy. In this population, SUDEP incidence is estimated at 0.5%. While the mechanisms of SUDEP are not completely understood, it appears that the majority of such death occurs in the immediate aftermath of a general tonic-clonic seizure.

There is currently no validated preventive treatment for SUDEP. Some evidence suggest that modulation of the serotoninergic tone, and more specifically selective serotonin recapture inhibitor (SSRI) such as fluoxetine, might prevent SUDEP. Indeed, fluoxetine prevents seizure-induced lethal central apneas in DBA/2 and DBA/1 mice, one of the few animal models of SUDEP. Furthermore, serotoninergic bulbar nuclei are known to play a major role in the control of breathing, especially during sleep and in response to repeated hypoxia.

In patients with epilepsy undergoing in-hospital video-EEG monitoring, about one third of seizures are associated with decrease in SpO2 <90%, an abnormality suspected to represent a risk factor of SUDEP. In a retrospective uncontrolled study, patients treated with SSRIs displayed less frequent ictal/post-ictal hypoxemia than patients not taking SSRIs.

The investigators project aimed at testing whether fluoxetine can reduce the risk of ictal/post-ictal hypoxemia by performing a double-blind, randomized, placebo-controlled trial in patients undergoing video-EEG monitoring as part of the pre-surgical evaluation of their focal drug-resistant epilepsy.

Conditions

Epilepsy; Ictal/Post-ictal Hypoxemia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

FLUOXETINE

4 weeks of treatment before video-EEG monitoring

Group Type: ACTIVE_COMPARATOR

fluoxetine 20 mg

Intervention Type: DRUG

Fluoxetine 20 mg per day during 4 weeks prior to video-EEG, then continued during video-EEG.

At the end of video-EEG, and according to patient's decision, treatment was either progressively withdrawn (1 week at 10 mg per day and then 1 week at 5 mg per day), or replaced by fluoxetine 20 mg open-label.

PLACEBO

1 month of treatment before EEG video.

Group Type: PLACEBO_COMPARATOR

placebo 20 mg

Intervention Type: DRUG

Placebo 20 mg per day during 4 weeks prior to video-EEG, then continued during video-EEG.

At the end of video-EEG, and according to patient's decision, treatment was either progressively withdrawn (1 week at 10 mg per day and then 1 week at 5 mg per day), or replaced by fluoxetine 20 mg open-label.

Interventions

fluoxetine 20 mg

Fluoxetine 20 mg per day during 4 weeks prior to video-EEG, then continued during video-EEG.

At the end of video-EEG, and according to patient's decision, treatment was either progressively withdrawn (1 week at 10 mg per day and then 1 week at 5 mg per day), or replaced by fluoxetine 20 mg open-label.

Intervention Type: DRUG

placebo 20 mg

Placebo 20 mg per day during 4 weeks prior to video-EEG, then continued during video-EEG.

At the end of video-EEG, and according to patient's decision, treatment was either progressively withdrawn (1 week at 10 mg per day and then 1 week at 5 mg per day), or replaced by fluoxetine 20 mg open-label.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

Patient suffering from drug-resistant focal epilepsy

• Age ≥ 18 years
• Patient for whom a video-EEG monitoring of their seizures was scheduled as part of a pre-surgical assessment
• For women of childbearing age, a method of contraception considered effective by the investigator
• Patient who have given their written informed consent
• Patient accepting an interview with a psychologist and to be refered to a psychiatrist in the event that mood disorders were detected on mood scores and considered severe by the investigator and / or psychologist, leading to require psychiatric care or immediate antidepressant treatment
• Patient with a social security number

Exclusion Criteria

• Age < 18 years

• Patient under legal protection
• Pregnant or breastfeeding women
• Hypersensitivity to fluoxetine or its excipients
• History of other serious side effects related to an earlier prescription of fluoxetine;
• Current suicidal ideation or history of suicide attempt
• Manic episode
• Disruption of liver enzymes considered material by the investigator using the following criteria:

transaminases (ALT and AST)> 2N alkaline phosphatase (ALP)> 2N gamma glutamyl transpeptidase (GGT)> 5N (performed as part of routine monitoring of epileptic patients on antiepileptic treatment. Patients often exhibit changed deemed clinically insignificant due to the enzyme-inducing effect of these drugs)

• Renal failure with creatinine clearance <30 ml / min
• Acute heart disease
• Antidepressant treatment
• Other prohibited treatment (see detailed list in protocol).

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Hospices Civils de Lyon

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Philippe RYVLIN, Professor

Role: STUDY_DIRECTOR

Hospices Civils de Lyon

Locations

Service de Neurologie Fonctionnelle et d'Epileptologie, Hôpital Neurologique

Lyon, , France

Countries

France

Other Identifiers

2009-562

Identifier Type: -

Identifier Source: org_study_id