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Treatment of Refractory Status Epilepticus

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ClinicalTrials.gov Identifier: NCT00265616
Recruitment Status : Terminated (Insufficient recruitment)
First Posted : December 15, 2005
Results First Posted : April 4, 2013
Last Update Posted : April 9, 2013
Sponsor:
Information provided by (Responsible Party):
Andrea O. Rossetti, MD, Brigham and Women's Hospital

Study Description
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Brief Summary:
The purpose of this study is to determine whether propofol or barbiturates should be preferred in the treatment of status epilepticus (continuous seizure activity) refractory to 2 standard antiepileptic agents.

Condition or disease Intervention/treatment Phase
Status Epilepticus Drug: propofol Drug: thiopental/pentobarbital Phase 3

Detailed Description:

Refractory status epilepticus (SE) develops in 31%-44% of patients with SE, with a mortality of 16%-23%. Coma induction is advocated for its management. Propofol and barbiturates are the most used agents, but no comparative study has been performed. In consideration of the uncertainty regarding the relative effectiveness, despite several retrospective data, a prospective investigation is needed.

The objective is to assess the effectiveness (SE control, adverse events) of a first course of propofol versus barbiturates in the treatment of refractory SE, in adults with refractory SE not due to cerebral anoxia.

Comparison: Coma induction with standardized doses of propofol or barbiturates titrated towards burst-suppression on EEG, then assessment of the proportion of patients achieving a control of SE.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 23 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Clinical Trial for the Treatment of Refractory Status Epilepticus
Study Start Date : May 2006
Actual Primary Completion Date : March 2010
Actual Study Completion Date : March 2010

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Arms and Interventions
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Arm Intervention/treatment
Active Comparator: 1
propofol, 2mg/kg as bolus, then titrated up to EEG burst-suppression as a continuous infusion; no maximum doses defined
 Drug: propofol
liquid, mg/kg.h, titrated after EEG
Other Name: Disoprivan
Active Comparator: 2
thiopental/pentobarbital, 2mg/kg as bolus, then titrated up to EEG burst-suppression as a continuous infusion; no maximum doses defined
 Drug: thiopental/pentobarbital
liquid, mg/kg.h, titrated after EEG
Other Name: Pentotal /Thiopentone


Outcome Measures
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Primary Outcome Measures :
  1. Refractory Status Epilepticus Controlled With First Course of Study Drug [ Time Frame: after return of continuous EEG activity (typically after 36 hours - 5 days) ]
    Control of status epilepticus refractory to benzodiazepines and a first antiepileptic drug after administration of the study drug; dichotomous assessment (yes/no)


Secondary Outcome Measures :
  1. Clinical Outcome at Day 21 [ Time Frame: 21 days ]
    Return to baseline clinical conditions (i.e.: no new handicap, no death)

  2. Patients With Infectious Complications Requiring Specific Treatment [ Time Frame: 10 days ]
  3. Patients With Hypotension Requiring Specific Treatment [ Time Frame: 10 days ]
  4. Patients With Propofol Infusion Syndrome [ Time Frame: 10 days ]
    Propofol infusion syndrome (PRIS) is a severe metabolic alteration with elevation of lactate, CK, and triglycerides.

  5. Intubation Time in Survivors [ Time Frame: Up to 3 months ]

Eligibility Criteria
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Ages Eligible for Study:   16 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with refractory status epilepticus not due to cerebral anoxia, needing coma induction for clinical management.

Exclusion Criteria:

  • Age < 16 years old.
  • Known pregnancy.
  • Cerebral anoxia as SE etiology.
  • Epilepsia partialis continua (simple partial SE).
  • Known intolerance to the study drugs.
  • Known mitochondrial disorder, hyperlipidemia, or significant rhabdomyolysis.
Contacts and Locations
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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 ClinicalTrials.gov identifier (NCT number): NCT00265616


Locations
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United States, Massachusetts
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
Brigham and Women's Hospital
Boston, Massachusetts, United States, 02115
Switzerland
Inselspital
Bern, BE, Switzerland
CHUV
Lausanne, VD, Switzerland
Hôpitaux Universitaires de Genève
Geneva, Switzerland
Sponsors and Collaborators
Brigham and Women's Hospital
Investigators
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Principal Investigator: Andrea O. Rossetti, MD BrighamHospital/CHUV
More Information
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Publications of Results:

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Responsible Party: Andrea O. Rossetti, MD, Dr, Brigham and Women's Hospital
ClinicalTrials.gov Identifier: NCT00265616    
Other Study ID Numbers: RSE study, protocol#62/06
First Posted: December 15, 2005    Key Record Dates
Results First Posted: April 4, 2013
Last Update Posted: April 9, 2013
Last Verified: April 2013
Keywords provided by Andrea O. Rossetti, MD, Brigham and Women's Hospital:
Refractory status epilepticus,
coma-induction,
treatment,
propofol,
 barbiturates,
efficacy,
safety.
Additional relevant MeSH terms:
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Status Epilepticus
Seizures
Neurologic Manifestations
Nervous System Diseases
Pentobarbital
Thiopental
Propofol
Hypnotics and Sedatives
Central Nervous System Depressants
Physiological Effects of Drugs
 Anesthetics, Intravenous
Anesthetics, General
Anesthetics
Anticonvulsants
GABA Modulators
GABA Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Adjuvants, Anesthesia