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Verapamil as Therapy for Children and Young Adults With Dravet Syndrome

This study has been completed.
Mayo Clinic
Ann & Robert H Lurie Children's Hospital of Chicago
Dartmouth-Hitchcock Medical Center
Information provided by (Responsible Party):
Beverly S. Wical, M.D., Gillette Children's Specialty Healthcare Identifier:
First received: May 24, 2012
Last updated: March 24, 2015
Last verified: March 2015
This study will assess how well the drug verapamil can improve control of seizures and dysautonomia symptoms in children and young adults diagnosed with Dravet syndrome. The safety of verapamil when given with all concomitant medications will also be assessed.

Condition Intervention Phase
Dravet Syndrome
Drug: Verapamil
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Verapamil as Adjunctive Seizure Therapy for Children and Young Adults With Dravet Syndrome

Resource links provided by NLM:

Further study details as provided by Gillette Children's Specialty Healthcare:

Primary Outcome Measures:
  • Seizure Frequency [ Time Frame: Baseline, 8 weeks, 12 weeks, 16 weeks, 24 weeks, and 35 weeks ]
    The primary study endpoint is GTCS seizure frequency. A reduction in the number and severity of seizures is anticipated.

Secondary Outcome Measures:
  • Frequency of myoclonic/absence/atypical absence seizures [ Time Frame: Baseline, 8 weeks, 12 weeks, 16 weeks, 24 weeks, and 35 weeks ]
    We anticipate a reduction in myoclonic, absence, and atypical absence seizures as well.

Enrollment: 2
Study Start Date: April 2012
Study Completion Date: January 2015
Primary Completion Date: January 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
open label adjunctive add on
open label adjunctive add on of verapamil to existing medications. dosing begins at 1 mg/kg/d and increases weekly to target of 4 mg/kg/d in divided doses (three times/day)
Drug: Verapamil

Verapamil will be prepared as a solution. A 50mg/ml oral suspension may be made with immediate release tablets and either a 1:1 mixture of Ora-Sweet and Ora-Plus or a 1:1 mixture of Ora-Sweet SF and Ora-Plus will be used.

Children will start on a 4 weeks titration period:

Week 1: 1mg/kg/day divided BID Week 2: 2mg/kg/day divided BID or TID Week 3: 3mg/kg/day divided BID or TID Week 4: 4mg/kg/day divided TID

In event of adverse events, and in consultation with the family and treating physician, the dosage may be decreased to 2mg/kg/day and remain at that dose for the remainder of the study.

Other Names:
  • Calan
  • Covera
  • Isoptin
  • Verelan

Detailed Description:

Dravet syndrome (DS) is a devastating form of pediatric seizure disorder (epilepsy), often related to abnormalities of one of the genes that controls sodium channel function in the brain (SCN1A). Most children with DS experience continued seizures even with optimal treatment of currently available anti-seizure therapies [1]. Many of these seizures are prolonged, and can be life threatening.

This pilot study will assess the efficacy of verapamil in improving control of seizures in children and young adults DS. This will be done by adding verapamil as open label adjunctive therapy to medications already being given. Investigators will assess the effect of verapamil therapy on seizure control and on signs of autonomic dysfunction observable to the parents/guardians. Signs of autonomic function include body temperature regulation, sweating, heart rate, pupil size, and flushing of the skin. Iannetti, et al reported treating 2 children with clinical DS (one with an SCN1A mutation) with verapamil as adjunctive therapy [2]. Both children had a positive clinical response persisting for a number of months. No adverse effects were noted. We have treated an additional 4 children with DS with verapamil. There have been no significant adverse effects; 3 of 4 have experienced improved seizure control for months also.

Verapamil has been shown to affect autonomic tone in patients with cardiac disorders (eg. high blood pressure, heart attack). It alters the balance between parts of the autonomic nervous system's function (called sympathetic and parasympathetic function) with a shift toward decreased sympathetic tone and increased parasympathetic (vagus nerve) tone [8, 9, 10]. Verapamil is used as an effective agent to treat certain types of autonomic headaches in both adults and children. In cluster headaches, autonomic symptoms (tearing, nasal congestion, facial sweating, papillary constriction) are prominent; verapamil is an accepted treatment [11, 12].

Intense emotion triggers seizures in a subset of children with DS. Modulation of autonomic function is likely an integral part of seizure threshold in those so affected. Children with DS have a higher rate of signs of abnormal autonomic function than do controls [13]. Cardiac autonomic control is also altered in these children, with a shift in the balance between sympathetic (relatively overactive) and parasympathetic (relatively less active) tone [14]. Similar findings have been identified in adults with intractable epilepsy and children with partial epilepsy [15, 16, 17]. Verapamil's action in stabilizing the balance of sympathetic and parasympathetic tone may play a role altering autonomic tone abnormalities in children with DS as well. This may be a part of the mechanism that leads to improved seizure control.

Verapamil has been in clinical use for ~ 25 years. The FDA has granted an Investigational New Drug approval for use of this medication in this population of children and young adults. Investigators propose to add it to the patient's existing medications, and evaluate potential improvement in seizure control. Potential side effects will be screened. Investigators will monitor liver function with blood tests as well as concentrations of anti-seizure medications. Verapamil and nor-verapamil levels will be assessed twice also. Testing of heart rhythm (EKG) will be done before the study starts and twice more during the study.


Ages Eligible for Study:   2 Years to 25 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • 2 to 25 years old
  • Onset of seizures in first year of life
  • seizure type usually generalized tonic-clonic, clonic, or hemiclonic, often prolonged (>10 minutes)
  • myoclonic jerks/myoclonic seizures
  • history of normal development at seizure onset with subsequent developmental delay or regression which occurs after seizure onset
  • presence of documented abnormality on the SCN1A gene
  • medically intractable epilepsy: must have been on at least 2 prior antiepileptic medications without adequate control of epilepsy
  • subject is capable of giving informed consent (or assent if possible) or has an acceptable surrogate capable of giving informed consent on the subject's behalf

Exclusion Criteria:

  • use of clonidine, propranolol, carbamazepine, oxcarbazine, stiripentol, lamotrigine, or cyclosporine
  • Abnormalities of cardiac conduction or rhythm (excluding sinus arrhythmia) on screening EKG
  • significant use of grapefruit juice
  • ketogenic diet
  • pregnancy
  Contacts and Locations
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Please refer to this study by its identifier: NCT01607073

United States, Illinois
Children's Memorial Hospital
Chicago, Illinois, United States, 60614
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
Gillette Children's Specialty Healthcare
St. Paul, Minnesota, United States, 55101
United States, New Hampshire
Mary Hitchcock Memorial Hospital
Lebanon, New Hampshire, United States, 03756
Sponsors and Collaborators
Beverly S. Wical, M.D.
Mayo Clinic
Ann & Robert H Lurie Children's Hospital of Chicago
Dartmouth-Hitchcock Medical Center
Principal Investigator: Beverly S Wical, MD Gillette Children's Specialty Healthcare
  More Information


Responsible Party: Beverly S. Wical, M.D., Pediatric Neurologist, Gillette Children's Specialty Healthcare Identifier: NCT01607073     History of Changes
Other Study ID Numbers: IND 113666
Study First Received: May 24, 2012
Last Updated: March 24, 2015

Keywords provided by Gillette Children's Specialty Healthcare:

Additional relevant MeSH terms:
Epilepsies, Myoclonic
Pathologic Processes
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Anti-Arrhythmia Agents
Calcium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Vasodilator Agents processed this record on April 21, 2017