Trial record 1 of 3 for:    "pyridoxine-dependent epilepsy" [DISEASE] OR "vitamin B6-dependent seizures" [DISEASE] OR NCT00552045 [ID-NUMBER] OR NCT00041600 [ID-NUMBER]
Previous Study | Return to List | Next Study

Neurodevelopmental Outcome of Early Dietary Lysine Restriction in Pyridoxine Dependent Epilepsy Patients (NOEL)

This study is not yet open for participant recruitment. (see Contacts and Locations)
Verified August 2013 by University of British Columbia
Sponsor:
Collaborators:
March of Dimes
British Columbia Childrens Hospital Foundation
Information provided by (Responsible Party):
University of British Columbia
ClinicalTrials.gov Identifier:
NCT01795170
First received: February 18, 2013
Last updated: August 23, 2013
Last verified: August 2013
  Purpose

Restricting dietary lysine intake in infants from age 3 months or less with confirmed diagnosis of pyridoxine-dependent epilepsy due to Antiquitin (ATQ) deficiency will: reduce the accumulation of neurotoxic substratesα-aminoadipicsemialdehydeandits cyclic equivalent 1-piperideine-6-carboxylate;and will improve overall neurodevelopmental outcome at 3 years of age by acting as an effective intervention into the complex pathophysiology of the condition.


Condition Intervention
Pyridoxine Dependant Epilepsy
Dietary Supplement: Lysine Restricted Diet
Drug: Pyridoxine

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: Neurodevelopmental Outcome of Early Dietary Lysine Restriction in Pyridoxine

Resource links provided by NLM:


Further study details as provided by University of British Columbia:

Primary Outcome Measures:
  • Neurocognitive development at age 3 years [ Time Frame: 3 years ] [ Designated as safety issue: No ]
    defined by total developmental index measured using the Bayley Scales for Infant and Toddler Development, 3rd Edition (Bayley-III)

  • Level of biochemical marker-α- aminoadipicsemialdehyde (AASA) in plasma and urine [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Seizure frequency: clinical and electrical (EEG) [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Quality of life [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Neurological deficits [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Other Outcome Measures:
  • Anthropometric measures [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]
  • Plasma lysine and branched chain amino acid levels [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]
  • Global nutritional assessment with plasma levels for albumin, prealbumin, total protein, iron parameters, zinc, selenium, CBC, folic acid, vitamin B12 [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]
  • Peripheral sensory neuropathy (relevant because the lysine restriction is expected to reduce chemical inactivation of pyridoxine, thus potentially increasing the risk of toxicity) [ Time Frame: 3 years ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 30
Study Start Date: April 2013
Estimated Study Completion Date: November 2016
Estimated Primary Completion Date: November 2016 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Test Group
Patients receiving a lysine restricted diet adjunct to pyridoxine therapy will be considered as participants in the 'exposure'/test group
Dietary Supplement: Lysine Restricted Diet
Daily lysine intake will be managed to maintain a plasma lysine level of 50-80 µmol/L (normal range: 52-196 µmol/L). Diet prescriptions will be based on international guidelines for glutaricaciduria type I, another inborn error of lysine catabolism. In order to meet the recommended daily protein intake (DRI) [23,24], the diet may include commercially available lysine-free amino acid formulas approved for use in conditions affecting lysine metabolism, as well as commercially available low-protein products based on the participant's taste.
Drug: Pyridoxine
All participants will be on 15-30 mg/kg/day of pyridoxine therapy up to a maximum of 500mg/day divided in 2-3 doses enterally
Control Group
Patients on pyridoxine mono-therapy will be participants in the 'control' group
Drug: Pyridoxine
All participants will be on 15-30 mg/kg/day of pyridoxine therapy up to a maximum of 500mg/day divided in 2-3 doses enterally

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   3 Months to 3 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Infants with pyridoxine-dependent epilepsy resulting from ATQ deficiency.

Criteria

Inclusion Criteria:

  • Diagnosis of pyridoxine-dependent epilepsy based on clinical symptoms and elevated levels of plasma or urine AASA. Confirmation by at least one known disease causing mutation in the ALDH7A1 gene to be obtained within one month of enrollment.
  • Participant is male or female <3 years of age.

    • Participants in the test arm have to be less than 3 months of age when the dietary restriction was started.
    • Participants in the control arm may be older than 3 months of age but must not be older than 3 years of age when they are enrolled into the study and must have been on pyridoxine treatment prior to age 3 months and not treated with dietary lysine restriction at any time during their life.
  • Participant is managed with a vitamin B6 dose of 15-30 mg/kg/day continuously beginning at < 3 months age, and willing to maintain this dose for the study duration.
  • Participants must have been offered dietary lysine restriction as adjunct therapy as part of standard clinical care.
  • Parent(s) or guardian(s) is willing and able to provide written informed consent after the nature of the study has been explained, and prior to any research-related procedures.

Exclusion Criteria:

  • Diagnosis is not confirmed: Participant does not have a mutation in the ALDH7A1 gene.
  • Participant was treated prenatally for PDE with pyridoxine (i.e. mother was on pyridoxine)
  • Timing of dietary restriction: Participant is on a lysine-restricted diet from an age > 3months.
  • Confounding factors:

    • Participant is a pre-term with a gestational age < 32 weeks
    • The participant has a birth weight less than the 2nd percentile or weighs less than 2nd percentile at study entrance (on age appropriate growth chart).
    • Participant shows an intracranial malformation or abnormality unrelated to ATQ deficiency, as diagnosed on the cranial ultrasound and/or MRI brain scan
    • Participant has any other disorder identified that can affect the cognitive function in the opinion of the coordinating principal investigators.
  • A known allergy or sensitivity to any component of the products commonly used in a lysine-restricted diet or to other products associated with lysine restriction or any other products associated with general study procedures.
  • Participant is on oral folinic acid and/or pyridoxal phosphate treatment at study entrance.
  • Participant has any condition or situation which, in the investigator's opinion, places the patient at significant risk of adverse events, or may interfere significantly with their participation and compliance in the study.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01795170

Contacts
Contact: Sravan Jaggumantri 604 875 2000 ext 5907 sravan.j@cw.bc.ca

Locations
United States, Colorado
Children's Hospital Colorado Not yet recruiting
Aurora, Colorado, United States, 80045
Contact: Johan van Hove         
Principal Investigator: Johan van Hove         
United States, Washington
Seattle Children's Hospital
Seattle, Washington, United States, 98105
Canada, British Columbia
BC Children's Hospital Not yet recruiting
Vancouver, British Columbia, Canada, V6H 3V4
Contact: Sravan Jaggumantri         
Principal Investigator: Clara van Karnebeek         
Sub-Investigator: Sravan Jaggumantri         
Principal Investigator: Sylvia Stockler         
Germany
Hannover Medical School Not yet recruiting
Hannover, Germany
Contact: Hans Hartman         
Principal Investigator: Hans Hartman         
Netherlands
Maxima Medical Center Not yet recruiting
Veldhoven, Netherlands
Contact: Levinus Bok         
Principal Investigator: Levinus Bok         
Switzerland
Kinderspital Zürich Not yet recruiting
Zürich, Switzerland
Contact: Barbara Plecko         
Principal Investigator: Barbara Plecko         
United Kingdom
University College London Not yet recruiting
London, United Kingdom
Contact: Philippa Mills         
Principal Investigator: Philippa Mills         
Sponsors and Collaborators
University of British Columbia
March of Dimes
British Columbia Childrens Hospital Foundation
Investigators
Principal Investigator: Clara van Karnebeek University of British Columbia
Principal Investigator: Sylvia Stockler University of British Columbia
  More Information

Publications:
Responsible Party: University of British Columbia
ClinicalTrials.gov Identifier: NCT01795170     History of Changes
Other Study ID Numbers: H12-03481
Study First Received: February 18, 2013
Last Updated: August 23, 2013
Health Authority: Canada: Health Canada
United States: Institutional Review Board
Germany: Ethics Commission
Netherlands: Medical Ethics Review Committee (METC)
Switzerland: Ethikkommission
United Kingdom: Research Ethics Committee

Keywords provided by University of British Columbia:
Pyridoxine Dependant Epilepsy
Antiquitin Deficiency
Lysine Restricted Diet

Additional relevant MeSH terms:
Epilepsy
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Pyridoxine
Vitamin B 6
Pyridoxal
Vitamin B Complex
Vitamins
Micronutrients
Growth Substances
Physiological Effects of Drugs
Pharmacologic Actions

ClinicalTrials.gov processed this record on August 28, 2014