Adults With Tonic Clonic Seizures and/or Partial Seizures Clinical Trial
Official title:
Second-Line Treatment Choice for Epilepsy
Most patients are prescribed valproate as their first antiepileptic drug. It is unknown which is the best second-line drug when patients do not become seizure free on valproate. This has led the Dutch Epilepsy Clinics Foundation (SEIN) to start the SLICE study. Adult patients with partial and/or tonic-clonic seizures, insufficiently responding to valproate, are recruited for this study. These patients are randomized to receive one of three other drugs. Patients wil initially use this drug next to valproate. Neurologists of more than 20 general hospitals en neurologists of SEIN are participating in this study.
The purpose of the project is to compare several antiepileptic drugs given to adult patients
with epilepsy after they have not become seizure free on valproate as a first-line
antiepileptic drug. The drugs will first be evaluated in combination with valproate and in
case of success (being a seizure reduction of more than 50%) will also be evaluated in
monotherapy.
Patients who did not become seizure free on valproate will be identified by neurologists in
the participating hospitals. When these patients are willing to participate, they are
randomized to one of three drugs: carbamazepine, lamotrigine and levetiracetam. In phase 1
of the project they keep on using valproate. The randomized second-line drugs will be
titrated to a first dose level and the effectiveness of the combinations will be evaluated.
When seizures persist and adverse effects allow it, the add-on drug is titrated to a second
dose level and again the effectiveness of the combination is evaluated. When seizures still
continue and adverse effects allow it, the add-on drug is titrated to a third and final dose
level. When a patient does not become seizure free on a combination on that final level or
adverse effects have prevented a dose increase to a higher level, that combination has
failed in phase 1. When the patients does become seizure free on his or her combination, the
combination is deemed a success for that patient. A patient will proceed to phase 2, when he
or she has at least experienced a 50% seizure reduction.
In phase 2 of the project the second-line drug will be given in monotherapy. This means that
valproate will be withdrawn. The dose of the second drug will be increased accordingly. The
effectiveness of the drugs in monotherapy will be evaluated. The combined results of phase 1
and 2 will enable us to interpret the results. When all patients who became seizure free on
a combination in phase 1, stay seizure free in phase 2, the efficacy of the combination
should be attributed to the add-on drug. When these patients all develop seizures again, the
efficacy of the combination should be attributed to the combination.
The primary outcome measure is percentage seizure free. Secondary outcome measures are
adverse effects and the results of clinimetric epilepsy scales. Serum levels will be
measured during the project. The projected sample size for each group has been lowered from
75 patients per group to 20 patients per group.
At this moment, neurologists of about 20 general hospitals are collaborating in this
project. Inclusion of patients will continue until June 2006. The follow-up of patients and
analysis of results will be carried until the projected end of the project.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment