Levetiracetam Versus Carbamazepine in Post-Stroke Late Onset Crisis (EpIc)
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ClinicalTrials.gov Identifier: NCT00542802 |
Recruitment Status : Unknown
Verified May 2008 by Scienze Neurologiche Ospedaliere.
Recruitment status was: Recruiting
First Posted : October 12, 2007
Last Update Posted : May 30, 2008
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Epileptic Seizures Stroke | Drug: Levetiracetam Drug: Carbamazepine | Phase 3 |
Stroke is the most common cause of seizures in the elderly and seizures are among the most common sequelae of stroke.
About 10% of patients experience seizures since stroke onset up to several years (Silverman 2002). Arbitrarly a cut point of 2 weeks divide early seizures from late seizures (Honey 2000, Olofson 2000, Berger 1989).Late occurrence of late seizure appears to carry a high risk for epilepsy (Wilmore 1990).
The risk of epilepsy in some patients with a single stroke-related seizure is high enough to justify starting an anticonvulsant therapy before a second seizure occurs(Labovitz 2003).
Levetiracetam (S-α-ethil-2-oxo-pyrrolidine acetamide) is S-enantiomer of a pyrrolidine derivative and is unrelated to any other AED and has a unique preclinical and clinical profile (Gower et al 1992).
Levetiracetam (LEV) binds with a stereospecific binding site in the CNS that is saturable and reversible (Noyer 1995). This site actually known as LBS Levetiracetam Binding Site) is unique and do not correspond to any known receptor or channel that might be involved in neuroexcitability (Gillard 2003).
LEV selectively inhibits N-type Ca2 channels of CA1 pyramidal hyppocampal neurons (Lukyanetz et a 2002) and, despite of not having any activity on GABA-gated currents, it shows a potent ability to reverse the inhibitory effects of the negative allosteric modulators zinc and β-carbolines on both GABAA and glycine receptor mediated responses(Rigo et al. 2002).
LEV has no effects on normal neurons (Birnstiel et al.1997) LEV as other AEDs has effect in decreasing repetitive neuronal firing, but only LEV reduces the number of cells firing synchronously (amplitude) of the evoked PS(Margineau and Klitgaard 2000).
The efficacy profile of the drug has been established through three pivotal randomized double blind, placebo controlled, parallel studies on 904 patients suffering from partial seizures secondarily or not generalised that were not well controlled by previous treatment (Shorvon et al. 2000; Ben-Menachem et al. 2000; Cereghino et al. 2000).In these three studies LEV showed a significant reduction of seizure frequency. A pooled analysis of the results from these three studies supports a dose-response effect for levetiracetam: responder rates were 28.5, 34.3 and 41.3 % for patients treated with levetiracetam 1000, 2000, 3000 mg/day respectively, as compared with 13.1% for placebo group. The respective values for complete seizure freedom were 4.7, 6.3, 8.6 and 0.8%(Privitera 2002, Boon et al, 2002).
In a review of data for 1422 patients treated with levetiracetam, 38.6% of patients experienced a ≥ 50% reduction in seizure frequency and 20% experienced a reduction of ≥ 75%. The present study is not blinded because one of the purposes with the study has been to mimic daily clinical practice as close as possible.
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 630 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Multicenter, Comparative, Randomized, Open Trial to Evaluate Efficacy and Safety of Levetiracetam Versus Carbamazepine in Post Stroke Late Onset Crisis |
Study Start Date : | September 2007 |
Estimated Primary Completion Date : | June 2009 |
Estimated Study Completion Date : | June 2009 |

Arm | Intervention/treatment |
---|---|
Experimental: LEV
Levetiracetam
|
Drug: Levetiracetam
Levetiracetam tablets 250-500 mg. The drug dosage will be up-titrated from 250 mg bid in the first 2 weeks to 500 mg bid during the rest of the treatment period. The dosage can be incremented until 1500 mg bid, at Investigator judgement if crisis continue, or it can be reduced in case of adverse events |
Active Comparator: CAR
Carbamazepina
|
Drug: Carbamazepine
Carbamazepina tablets 200 mg. The drug dosage will be up-titrated from 100 mg die in the first 3 days to 100 mg bid during days 4 to 7, to 200 mg bid in the 2nd week, to 300 mg bid during the rest of the treatment period. The dosage can be incremented until 800 mg bid, at Investigator judgement if crisis continue, or it can be reduced in case of adverse events |
- number of patients free from post stroke recurrent crisis [ Time Frame: one year ]
- To compare retention time of LEV vs CBZ since first intake throughout treatment period [ Time Frame: one year ]
- To compare time to second seizure in both treatments. [ Time Frame: one year ]
- To evaluate differences in cognitive function and in quality of life in levetiracetam and carbamazepine patients having post-stroke seizures at the end of treatment period [ Time Frame: one year ]
- evaluate EEG changes as compared with baseline with that obtained at the end of treatment period [ Time Frame: one year ]
- To compare seizure frequency in levetiracetam and carbamazepine groups throughout treatment period [ Time Frame: one year ]
- To evaluate the safety of levetiracetam versus carbamazepine throughout the treatment period [ Time Frame: one year ]

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, Learn About Clinical Studies.
Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients having a stroke (ischemic and haemorrhagic) showing (one) subsequent seizure 14 days up to 3 years after stroke
- Patients has signed the informed consent form
- Aged ≥ 18 years
Exclusion Criteria:
- Severe stroke patients with Rankin scale > 3
- Patients with a life expectancy of < 12 months
- Patients screened more than 15 days after first seizure
- Patients with a diagnosed epilepsy
- Patients with clear evidence of myoclonic seizures
- Patients with contraindication to levetiracetam and carbamazepine use
- Patients presenting epileptic status at onset
- Patients having a MMSE <24
- Patients having a seizure before stroke
- Patients taking any AED 4 weeks prior to randomisation in the study
- Patients showing dysphagia after stroke not able to swallow tablets.
- Patients with a low compliance for the study
- Pregnant women, lactating or sexually active women with childbearing potential who are not using a medically accepted birth control method.
- Allergy or intolerance to pyrrolidine derivatives and/or tablet excipients or to carbamazepine derivates and /or tablet excipients
- Patients involved in another clinical trial 30 days prior randomization
- Patients with any tumour
- Patients with previous traumatic brain accident resulting in impairment of consciousness.
- Patients for whom it is not possible to assess seizure onset

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00542802
Contact: Domenico Consoli, Doctor | domco@tiscali.it | ||
Contact: Sara Papetti | 0382 530676 ext +39 | spapetti@gbpharmaservices.it |
Italy | |
Ospedale S. Giacomo | Not yet recruiting |
Novi Ligure, AL, Italy, 15057 | |
Principal Investigator: MARCO AGUGGIA | |
Ospedale S. Croce E Carle | Not yet recruiting |
Cuneo, CN, Italy, 12100 | |
Principal Investigator: ENZO GRASSO | |
Ospedale S. Martino | Recruiting |
Genova, GE, Italy, 16132 | |
Principal Investigator: GIOVANNI REGESTA | |
Istituto Clinico Humanitas | Recruiting |
Rozzano, MI, Italy, 20089 | |
Principal Investigator: GIUSEPPE MICIELI | |
USL 2 Ospedale B.G. Villa | Not yet recruiting |
Città della Pieve, PG, Italy, 06062 | |
Principal Investigator: STEFANO RICCI | |
Ospedale Civile San Giovanni Battista di Foligno | Recruiting |
Foligno, PG, Italy | |
Principal Investigator: Pierluigi BRUSTENGHI | |
Ospedale Santa Maria della Misericordia | Not yet recruiting |
Sant'Andrea delle Fratte, PG, Italy, 06131 | |
Principal Investigator: ANNA CANTISANI | |
Istituto Neurologico C. Mondino | Not yet recruiting |
Pavia, PV, Italy, 27100 | |
Contact: Anna Cavallini, doctor | |
Principal Investigator: Anna Cavallini, doctor | |
Ospedale Guzzardi | Recruiting |
Vittoria, RG, Italy, 97019 | |
Principal Investigator: FRANCESCO IEMOLO | |
Ospedale Di Portogruaro | Recruiting |
Portogruaro, VE, Italy, 30026 | |
Principal Investigator: SEBASTIANO D'ANNA | |
Ospedale Civile | Recruiting |
Vibo Valentia, VV, Italy, 89900 | |
Principal Investigator: domenico consoli, doctor | |
Policlinico Umberto I | Not yet recruiting |
Ancona, Italy, 60020 | |
Principal Investigator: LEANDRO PROVINCIALI | |
Ospedale A. Perrino | Recruiting |
Brindisi, Italy, 72100 | |
Principal Investigator: BRUNO PASSARELLA | |
Ospedale Cannizzaro | Not yet recruiting |
Catania, Italy, 95126 | |
Principal Investigator: ERMINIO COSTANZO | |
Ospedale San Martino | Recruiting |
Genova, Italy | |
Principal Investigator: carlo GANDOLFO | |
Ospedale Civile Imperia ASL 1 | Recruiting |
Imperia, Italy, 18100 | |
Principal Investigator: Carlo SERRATI | |
Ospedale A. Cardarelli- | Recruiting |
Napoli, Italy, 80131 | |
Principal Investigator: MAURO PAGLIUCA, Dr. | |
Ospedale Cardarelli | Not yet recruiting |
Napoli, Italy, 80131 | |
Principal Investigator: VINCENZO ROSSI | |
Ospedale Civico | Not yet recruiting |
Palermo, Italy, 90100 | |
Principal Investigator: ERALDO NATALE' | |
Osp. Guglielmo da saliceto | Recruiting |
Piacenza, Italy, 29100 | |
Principal Investigator: DONATA GUIDETTI | |
Arcispedale S. Maria Nuova | Recruiting |
Reggio Emilia, Italy, 42100 | |
Principal Investigator: Romana RIZZI | |
Ospedale SS. Annunziata - Ospedale Civile | Recruiting |
Taranto, Italy | |
Principal Investigator: saverio INTERNO' | |
Ospedale Molinette-Università di Torino | Recruiting |
Torino, Italy | |
Principal Investigator: Dario GIOBBE | |
Azienda Ospedaliera Universitaria Trieste | Recruiting |
Trieste, Italy, 34149 | |
Principal Investigator: FABIO CHIODO GRANDI |
Principal Investigator: | domenico consoli, doctor | Ospedale Civile Vibo Valentia |
Publications:
Responsible Party: | Dr. Domenico Consoli, Scienze Neurologiche Ospedaliere |
ClinicalTrials.gov Identifier: | NCT00542802 History of Changes |
Other Study ID Numbers: |
EpIc 1151 |
First Posted: | October 12, 2007 Key Record Dates |
Last Update Posted: | May 30, 2008 |
Last Verified: | May 2008 |
post stroke epileptic late onset seizures |
Stroke Seizures Epilepsy Cerebrovascular Disorders Brain Diseases Central Nervous System Diseases Nervous System Diseases Vascular Diseases Cardiovascular Diseases Neurologic Manifestations Signs and Symptoms Carbamazepine Levetiracetam Anticonvulsants Nootropic Agents |
Antimanic Agents Tranquilizing Agents Central Nervous System Depressants Physiological Effects of Drugs Psychotropic Drugs Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System Agents Sodium Channel Blockers Membrane Transport Modulators Molecular Mechanisms of Pharmacological Action Cytochrome P-450 CYP3A Inducers Cytochrome P-450 Enzyme Inducers |