The Benefit and Safety of Older Generation Anti-Epileptic Drugs (AEDs) in Drug-Resistant Epilepsy Children

NCT ID: NCT05697614

Last Updated: 2023-01-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-03-01

Study Completion Date

2023-06-30

Brief Summary

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The goal of this interventional study is to learn about the efficacy and safety of first line anti epileptic drugs (AEDs) as substitution therapy for children who are resistant to second-line AEDs. The main question to answer it aims are :

how much the difference proportion of responders (responders are children who achieve the decrease of seizure frequencies by 50%) how much time it is needed to achieve the decrease of seizure frequencies by 50% The patients who are eligible for the study and have given their consent, will be enrolled, divided into 2 groups, the control and intervention.

The participant should follow the 14 weeks of intervention that consists of 6 phases : baseline, initial dose, titration dose, maintenance dose, tapering-off dose, and new combination maintenance dose.

Detailed Description

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Each phase of the study is described below

In baseline phase, data such as demographic, clinical characteristic including seizure frequency, seizure type, seizure onset, medication history, family history of seizure, and also developmental stages, will be recorded from electronic medical record. Besides, the CT-scan or MRI are also collected from the same source. After that, their quality of life will be assessed by QOLCE-55 validated questionnaire through self-guided report. Furthermore, the laboratory investigation and EEG will be performed.

The next phase is intervention phase, started from initial phase and ended by the maintenance of new combination therapy phase, takes with overall 12 weeks. Initially, the substitution drugs with each initial dose are consumed. The drugs consist of valproic acid for the generalized and carbamazepine for focal epilepsies.

On the other hand, the control group will take lamotrigine or clobazam for generalized and oxcarbazepine for focal ones. The phase continuous to titration dose, in which, the dose is raised gradually until it causes 50% of seizure reduction, and the next step is maintained the dose for about 2 weeks.

\- The following is tapering-off and after that stopping the substituted drug, levetiracetam or topiramate, which is determined by considering individual condition. Yet, if the seizures increase more than one and a half time of the previous frequency during the phases, the intervention will be ended immediately. On the contrary, if the condition is better, then the children go to the maintenance of new combination, that is the substitution drug and the old drugs in which the seizures do not go up or even better keep going down.

Conditions

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Drug Resistant Epilepsy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The subjects will be randomized into 2 groups : intervention and control. The subjects will be recruited by consecutive sampling technique
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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intervention

valproic acid 15 - 60 mg/kg body weight/day, divided into 2 dosages/day for 12 weeks ; carbamazepine 10 - 30 mg/kg body weight/day, divided into 2 dosages/day for 12 weeks ; phenytoin 5-7 mg/kg body weight/day, divided into 2 dosages/day for 12 weeks

Group Type EXPERIMENTAL

Valproic acid

Intervention Type DRUG

valproic acid is used for general epilepsy type, used in experimental group

Carbamazepin

Intervention Type DRUG

carbamazepine is used for focal type epilepsy, used in experimental group

Phenytoin

Intervention Type DRUG

phenytoin is used for both general or focal epilepsy in case valproic acid or carbamazepine is contraindicated, used in experimental group

control

lamotrigine 0.2 mg/kg body weight/day, divided into 2 dosages/day for 12 weeks ; clobazam 0.1 - 0.8 body weight/day, divided into 2 dosages/day for 12 weeks ; oxcarbazepine10 - 30 mg/kg body weight/day, divided into 2 dosages/day for 12 weeks

Group Type ACTIVE_COMPARATOR

Lamotrigine

Intervention Type DRUG

lamotrigine is used for general epilepsy type, used in control group

Clobazam

Intervention Type DRUG

clobazam is used for both general or focal epilepsy in case if lamotrigine or oxcarbazepine is not possible to be administered and is used particularly in myoclonic jerk , used in control group

Oxcarbazepine

Intervention Type DRUG

oxcarbazepine is used for focal type epilepsy, used in control group

Interventions

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Valproic acid

valproic acid is used for general epilepsy type, used in experimental group

Intervention Type DRUG

Carbamazepin

carbamazepine is used for focal type epilepsy, used in experimental group

Intervention Type DRUG

Phenytoin

phenytoin is used for both general or focal epilepsy in case valproic acid or carbamazepine is contraindicated, used in experimental group

Intervention Type DRUG

Lamotrigine

lamotrigine is used for general epilepsy type, used in control group

Intervention Type DRUG

Clobazam

clobazam is used for both general or focal epilepsy in case if lamotrigine or oxcarbazepine is not possible to be administered and is used particularly in myoclonic jerk , used in control group

Intervention Type DRUG

Oxcarbazepine

oxcarbazepine is used for focal type epilepsy, used in control group

Intervention Type DRUG

Other Intervention Names

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sodium divalproex depaken tegretol bamgetol kutoine lamictal frisium trileptal

Eligibility Criteria

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Inclusion Criteria

1. Children age at 1 - 18 years old
2. Children diagnosed as drug-resistant epilepsy by pediatric neurologists, diagnosis was based on the ILAE 2017 criteria
3. Children will have got at least 3 months of combination therapy that consists of levetiracetam of topiramate with optimal dosage but haven't got seizure reduction

Exclusion Criteria

1. Non-convulsive epilepsy
2. Suffered from status epilepticus in the prior 3 months before the study begins Past medical history of idiosyncrasies or severe adverse drug reactions caused by the
3. substitution therapy that will be given
Minimum Eligible Age

1 Year

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Dr Cipto Mangunkusumo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Roro Rukmi Windi Perdani

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Roro Rukmi Windi Perdani Pediatrician

Role: PRINCIPAL_INVESTIGATOR

Cipto Mangunkusumo Hopsital - Medical Faculty of Indonesia University

Locations

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Cipto Mangunkusumo Hospital

Jakarta Pusat, Jakarta Special Capital Region, Indonesia

Site Status RECRUITING

Harapan Kita Hospital

Jakarta, , Indonesia

Site Status RECRUITING

Fatmawati Hospital

Jakarta, , Indonesia

Site Status RECRUITING

Countries

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Indonesia

Central Contacts

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Roro Rukmi Windi Perdani Pediatrician

Role: CONTACT

+6281373679940

Wawaimuli Arozal Ph.D

Role: CONTACT

+6281808408680

Facility Contacts

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Irawan Mangunatmadja

Role: primary

+6281314578483

R. Anna Tjandrajani

Role: primary

+628129114513

Deddy Ria

Role: primary

+628121050511

References

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Perdani RRW, Arozal W, Mangunatmadja I, Kaswandani N, Handryastuti S, Medise BE, Hardi H, Thandavarayan RA, Oswari H. The efficacy and safety of first-line anti-seizure medications as substitution therapy for children with drug-resistant epilepsy: a randomized controlled trial protocol. Front Neurol. 2023 Aug 7;14:1237183. doi: 10.3389/fneur.2023.1237183. eCollection 2023.

Reference Type DERIVED
PMID: 37609651 (View on PubMed)

Provided Documents

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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Other Identifiers

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22-09-1097

Identifier Type: -

Identifier Source: org_study_id

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