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Levetiracetam Versus Carbamazepine in Post-Stroke Late Onset Crisis (EpIc)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. 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
Information provided by:
Scienze Neurologiche Ospedaliere

Brief Summary:
The principal purpose of the study is to determine the efficacy and safety of Levetiracetam versus Carbamazepine, intended as the number of patients free from crisis during the whole period of treatment, in patients affected by post stroke late onset crisis.

Condition or disease Intervention/treatment Phase
Epileptic Seizures Stroke Drug: Levetiracetam Drug: Carbamazepine Phase 3

Detailed Description:

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.

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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

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Seizures

Arm Intervention/treatment
Experimental: LEV
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
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

Primary Outcome Measures :
  1. number of patients free from post stroke recurrent crisis [ Time Frame: one year ]

Secondary Outcome Measures :
  1. To compare retention time of LEV vs CBZ since first intake throughout treatment period [ Time Frame: one year ]
  2. To compare time to second seizure in both treatments. [ Time Frame: one year ]
  3. 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 ]
  4. evaluate EEG changes as compared with baseline with that obtained at the end of treatment period [ Time Frame: one year ]
  5. To compare seizure frequency in levetiracetam and carbamazepine groups throughout treatment period [ Time Frame: one year ]
  6. To evaluate the safety of levetiracetam versus carbamazepine throughout the treatment period [ Time Frame: one year ]

Information from the National Library of Medicine

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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

Information from the National Library of Medicine

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 identifier (NCT number): NCT00542802

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Contact: Domenico Consoli, Doctor
Contact: Sara Papetti 0382 530676 ext +39

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Sponsors and Collaborators
Scienze Neurologiche Ospedaliere
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Principal Investigator: domenico consoli, doctor Ospedale Civile Vibo Valentia
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Responsible Party: Dr. Domenico Consoli, Scienze Neurologiche Ospedaliere Identifier: NCT00542802    
Other Study ID Numbers: EpIc 1151
First Posted: October 12, 2007    Key Record Dates
Last Update Posted: May 30, 2008
Last Verified: May 2008
Keywords provided by Scienze Neurologiche Ospedaliere:
post stroke epileptic late onset seizures
Additional relevant MeSH terms:
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Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Neurologic Manifestations
Nootropic Agents
Antimanic Agents
Tranquilizing Agents
Central Nervous System Depressants
Physiological Effects of Drugs
Psychotropic Drugs
Analgesics, Non-Narcotic
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