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Preventing Epilepsy After Traumatic Brain Injury With Topiramate (PEPTO)

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ClinicalTrials.gov Identifier: NCT00598923
Recruitment Status : Terminated (End of funding and low enrollment)
First Posted : January 23, 2008
Last Update Posted : June 27, 2017
Information provided by (Responsible Party):

January 11, 2008
January 23, 2008
June 27, 2017
November 2004
February 2009   (Final data collection date for primary outcome measure)
  • Early and late seizures after traumatic brain injury [ Time Frame: 2 years ]
  • Adverse events [ Time Frame: 2 years ]
Same as current
Complete list of historical versions of study NCT00598923 on ClinicalTrials.gov Archive Site
Functional recovery after traumatic brain injury [ Time Frame: 2 years ]
Same as current
Not Provided
Not Provided
Preventing Epilepsy After Traumatic Brain Injury With Topiramate
Preventing Epilepsy After Traumatic Brain Injury: A Pilot, Single-center Randomized Trial of Topiramate to Prevent Seizures After Moderate to Severe TBI
Our hypothesis is that topiramate will reduce acute seizures after traumatic brain injury and will help prevent the development of epilepsy after traumatic brain injury.
Traumatic brain injury (TBI) causes epilepsy in up to 30% of civilian and 50% of military head injuries, exacerbating chronic neurological disability. There is currently no method for preventing epilepsy after TBI. We hypothesize that the new antiepileptic drug, topiramate (TPM), will (1) reduce acute seizures and prevent the development of epilepsy following TBI and (2) improve neurological recovery. We propose to perform a pilot clinical trial to develop the necessary infrastructure for larger scale randomized clinical trials to test TPM, and, possibly, other new antiepileptic drugs with neuroprotective properties, for their ability to prevent epilepsy after TBI. Subjects with TBI will be randomized within 24 hours to one of three groups: 1) TPM for one week, 2) TPM for three months, or 3) phenytoin for one week. Subjects will be followed for two years for the development of seizures and for neurological outcome. Serial EEGs and MRIs will be performed to explore potential mechanisms for the development of epilepsy after TBI. These new tools for the clinical study of epilepsy prevention, and neuroprotection in general, will be developed that can be applied to a wide variety of studies and which will facilitate future research in this critical area.
Early Phase 1
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
  • Traumatic Brain Injury
  • Epilepsy
  • Drug: topiramate
    100 mg twice per day for 3 months
    Other Name: Topamax
  • Drug: topiramate
    100 twice per day for 6 days after loading dose of phenytoin
    Other Name: Topamax
  • Drug: phenytoin
    loading dose of 20 mg/kg and then 300 mg/day for total of 7 days
    Other Name: Dilantin
  • Experimental: 1
    Phenytoin 20mg/kg load, then Topiramate, 100 mg twice daily, starting at 24 hours post-TBI for 6 days.
    Intervention: Drug: topiramate
  • Experimental: 2
    topiramate for 3 months after loading dose of phenytoin
    Intervention: Drug: topiramate
  • Placebo Comparator: 3
    Phenytoin 20 mg/kg as loading dose than 300 mg/day for total of 7 days
    Intervention: Drug: phenytoin
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
February 2009
February 2009   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Moderate to severe traumatic brain injury, defined as one or more of the following: penetrating head wound seizure within the first hour after injury intracerebral hematoma or cortical contusion subdural or epidural hematoma Glasgow Coma Score <= 12 or motor score 1-5 (if intubated). Patients who have been pharmacologically paralyzed will be evaluated after the paralytic has worn off or been pharmacologically reversed depressed skull fracture requirement for emergent neurosurgical procedure
  2. Time since TBI less than 24 hours
  3. Age greater than or equal to 18 years
  4. Subject capable of giving informed consent or have an acceptable surrogate capable of giving consent on the subject's behalf. -

Exclusion Criteria:

  1. Known prior history of epilepsy or unprovoked seizures. Patients with a history of acute symptomatic seizures (e.g. febrile seizure, alcohol withdrawal seizure) will not be excluded
  2. Administration of an antiepileptic drug before enrollment
  3. History of allergy to topiramate or phenytoin
  4. Pregnancy or breast-feeding. Women of childbearing potential must have a negative pregnancy test (urine pregnancy test or serum beta-HCG) before randomization
  5. Compromised renal function with serum creatinine > 2
  6. Severe concurrent illness with life expectancy <6 months
  7. Treatment with another investigational agent for TBI
  8. Unable to take medications orally and contraindication to placement of nasogastric tube.
  9. Irreversibly fatal TBI

    1. All four findings: Glasgow Coma Score = 3, no pupillary reaction, age > 45 years, and severe coagulopathy OR
    2. Severe brainstem lesion on neuroimaging studies
  10. Patients with a history of kidney stones or glaucoma.
  11. Inability to maintain adequate fluid intake while taking topiramate.
  12. Patients whose TBI is a result of self inflicted injury
  13. Patient's who are currently using illicit drugs -
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
Contact information is only displayed when the study is recruiting subjects
Not Provided
United States
Not Provided
Not Provided
University of Pennsylvania
University of Pennsylvania
Not Provided
Principal Investigator: Marc A Dichter, MD, PhD University of Pennsylvania
University of Pennsylvania
June 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP