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Pharmacological Management of Seizures Post Traumatic Brain Injury (MAST)

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ClinicalTrials.gov Identifier: NCT04573803
Recruitment Status : Not yet recruiting
First Posted : October 5, 2020
Last Update Posted : November 3, 2020
Sponsor:
Collaborator:
University of Cambridge
Information provided by (Responsible Party):
Peter Hutchinson, University of Cambridge

Brief Summary:
The overall aim of the MAST trial is to define best practice in the use of anti-epileptic drugs (AEDs) for patients following a traumatic brain injury (TBI). The trial will consist of two parts. The first part aims to answer whether a shorter or a longer course of AEDs is better to prevent further seizures in patients who have started having seizures following TBI (MAST - duration). The second part aims to answer whether a 7-day course of either Phenytoin or Levetiracetam should be used for patients with a serious TBI to prevent seizures from starting (MAST- prophylaxis).

Condition or disease Intervention/treatment Phase
Traumatic Brain Injury Post Traumatic Seizures Drug: Phenytoin Sodium Drug: Levetiracetam Phase 3

Detailed Description:

The majority of patients who suffer a traumatic brain injury (TBI) do not need to stay in hospital overnight. However, some require admission to a specialist hospital, as their injury is more serious. Seizures can be harmful or even fatal, if not treated appropriately. Medications that reduce the risk of seizures are called antiepileptic drugs (AEDs). However, AEDs have side effects, which can affect patients' quality of life, memory, concentration and general health.

Patients with seizures after TBI are typically prescribed an AED to prevent further seizures, most commonly Phenytoin or Levetiracetam. Some doctors favour a short course, whereas others favour a longer course. The first part of the trial aims to answer if one approach is better than the other (MAST-duration). The second part of the trial aims to answer if a 7-day course of either Phenytoin or Levetiracetam should be used for patients with a serious TBI to prevent seizures from happening (MAST- prophylaxis).

All patients admitted to a neurosurgical unit (NSU) within the UK, with a serious TBI, will be considered for the trial. Patients who have been started on either Phenytoin or Levetiracteam by their clinical team due to seizures will be randomised to either up to 3 months or at least 6 months of treatment. In an independent, parallel trial, TBI patients who have not had a seizure will be randomised to phenytoin, levetiracetam or no treatment. All patients will be managed as per usual NHS practice and followed up for 24 months.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 1649 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The MAST trial consists of two pragmatic, open-label, multi-centre, independent, parallel, randomised trials. MAST-DURATION consists of two arms and MAST-PROPHYLAXIS consists of three arms.
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Pharmacological Management of Seizures Post Traumatic Brain Injury (MAST)
Estimated Study Start Date : March 1, 2021
Estimated Primary Completion Date : March 1, 2026
Estimated Study Completion Date : March 1, 2028

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: MAST DURATION - <3 months
TBI patients with early seizures (within first 7 days following trauma) will receive a short course of up to 3 months of either Phenytoin Sodium or Levetiracetam.
Drug: Phenytoin Sodium
Dosing will be as prescribed clinically by the treating physician. Phenytoin Sodium may be administered orally, intravenously or via nasogastric tube.

Drug: Levetiracetam
Dosing will be as prescribed clinically by the treating physician.Levetiracetam may be administered orally, intravenously or via nasogastric tube.
Other Name: Keppra

Experimental: MAST DURATION - >6 months
TBI patients with early seizures (within first 7 days following trauma) will receive a longer course of at least 6 months of either Phenytoin Sodium or Levetiracetam.
Drug: Phenytoin Sodium
Dosing will be as prescribed clinically by the treating physician. Phenytoin Sodium may be administered orally, intravenously or via nasogastric tube.

Drug: Levetiracetam
Dosing will be as prescribed clinically by the treating physician.Levetiracetam may be administered orally, intravenously or via nasogastric tube.
Other Name: Keppra

Experimental: MAST PROPHYLAXIS - Phenytoin Sodium
TBI patients, without an acute symptomatic seizure, will receive a 7-day course of Phenytoin Sodium as seizure prophylaxis.
Drug: Phenytoin Sodium
Dosing will be as prescribed clinically by the treating physician. Phenytoin Sodium may be administered orally, intravenously or via nasogastric tube.

Experimental: MAST PROPHYLAXIS - Levetiracetam
TBI patients, without an acute symptomatic seizure, will receive a 7-day course of Levetiracetam as seizure prophylaxis. Dosing will be as prescribed clinically by the treating physician.
Drug: Levetiracetam
Dosing will be as prescribed clinically by the treating physician.Levetiracetam may be administered orally, intravenously or via nasogastric tube.
Other Name: Keppra

No Intervention: MAST PROPHYLAXIS - no treatment
TBI patients, without an acute symptomatic seizure, will not receive any anti-epileptic drug.



Primary Outcome Measures :
  1. MAST-DURATION: Occurrence of late PTS [ Time Frame: Within 24 months post traumatic brain injury ]
    The primary outcome for MAST-DURATION is the occurrence of late post-traumatic seizure. This will be assessed by follow-up questionnaire.

  2. MAST-PROPHYLAXIS: Occurrence of PTS [ Time Frame: Within 2 weeks post TBI ]
    The primary outcome for MAST-PROPHYLAXIS is the occurrence of an acute symptomatic seizure. This will be assessed in the neurosurgical unit, or by telephone following discharge.


Secondary Outcome Measures :
  1. MAST-PROPHYLAXIS: Occurrence of post-traumatic seizures [ Time Frame: Within 24 months post traumatic brain injury ]
    The occurrence of post-traumatic seizures. This will be assessed by follow-up questionnaire.

  2. MAST-PROPHYLAXIS: Time to post-traumatic seizure [ Time Frame: Within 24 months post traumatic brain injury ]
    The time to post traumatic seizure. This will be assessed by follow-up questionnaire.

  3. Both trials: Disability [ Time Frame: At 6, 12, 18 and 24 months ]
    Levels of disability will be assessed using the Extended Glasgow Outcome Scale via follow-up questionnaire. The scale is scored from 1 (death) to 8 (upper good recovery) with higher scores reflecting a better outcome.

  4. Both trials: Cognitive function [ Time Frame: At 6, 12, 18 and 24 months ]
    Cognitive function will be assessed using the Neurobehavioural Symptom Inventory via follow-up questionnaire. Symptoms are scored from 0 (mild) to 4 (very severe) with higher scores reflecting a worse outcome.

  5. Both trials: Quality of life [ Time Frame: At 6, 12, 18 and 24 months ]
    Quality of life will be assessed using the EQ-5D-5L via follow-up questionnaire. The EQ-5D-5L consists of 2 parts - the EQ-5D-5L descriptive system and the EQ Visual Analogue scale. The descriptive system comprises 5 dimensions (mobility, self care, usual activities, pain/discomfort, anxiety/depression) which are scored from 1 (no problems) to 5 (extreme problems) with higher scores reflecting a worse outcome. The EQ Visual Analogue scale is numbered 0 to 100 with higher scores reflecting a better outcome.

  6. Both trials: Adverse events [ Time Frame: At 6, 12, 18 and 24 months ]
    Adverse events will be assessed using the Liverpool Adverse Events Profile via follow-up questionnaire. The questionnaire is scored from 1 (never a problem) to 4 (always or often a problem) with higher scores reflecting a worse outcome.

  7. Both trials: Hospital admissions [ Time Frame: Within 24 months post traumatic brain injury ]
    Hospital admissions will be extracted from the NHS Digital Hospital Episode Statistics (HES) database) and equivalents. Hospital admissions will be combined with the length of anti-epileptic drug treatment to report an economic evaluation.

  8. Both trials: Frequency of PTS [ Time Frame: Within 24 months post traumatic brain injury ]
    The frequency of post traumatic seizures.

  9. Both trials: Mortality [ Time Frame: At 6, 12, 18 and 24 months ]
    Death from any cause

  10. Both trials: Frequency of adverse events of special interest [ Time Frame: Up to 24 months ]
    Frequency of adverse events of special interest (unfavourable and unintended sign, symptom, or disease temporally associated with the use of trial drug, whether or not considered related to the trial drug.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   10 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

MAST DURATION

Inclusion Criteria:

  • Patients aged ≥10 years with TBI managed in an NSU who have started on an phenytoin or levetiracetam due to an acute symptomatic seizure during acute hospitalisation
  • Patient or Legal Representative is willing and able to provide informed consent or in the absence of a legal representative, an Independent Healthcare Professional provides authorisation for patient enrolment

Exclusion Criteria:

  • Unsurvivable injury
  • Previous history of epilepsy
  • Patients who are on an AED pre-TBI
  • Patient who has been clinically prescribed an AED other than phenytoin or levetiracetam
  • Unwillingness to take products containing gelatin (animal products)
  • Severe lactose intolerance or any known hypersensitivity to study drug or any of its excipients

MAST-PROPHYLAXIS

Inclusion Criteria:

  • Patients aged ≥10 years, with TBI managed in an NSU without an acute symptomatic seizure
  • Patient or Legal Representative is willing and able to provide informed consent or in the absence of a legal representative, an Independent Healthcare Professional provides authorisation for patient enrolment within 48 hours of admittance.

Exclusion Criteria:

  • Post-traumatic seizures
  • Unsurvivable injury
  • Previous history of epilepsy
  • Patients who are on an AED pre-TBI
  • Pregnancy or breastfeeding
  • Unwillingness to take products containing gelatin (animal products)
  • Severe lactose intolerance or any known hypersensitivity to study drug or any of its excipients
  • Time interval from the time of admission to NSU to randomisation exceeds 48 hours

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): NCT04573803


Contacts
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Contact: Samantha Lawes, PhD 07891 432226 samantha.lawes@addenbrookes.nhs.uk

Sponsors and Collaborators
Cambridge University Hospitals NHS Foundation Trust
University of Cambridge
Investigators
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Principal Investigator: Peter Hutchinson, PhD University of Cambridge
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Responsible Party: Peter Hutchinson, Professor of Neurosurgery & Honorary Consultant Neurosurgeon, University of Cambridge
ClinicalTrials.gov Identifier: NCT04573803    
Other Study ID Numbers: A095460
First Posted: October 5, 2020    Key Record Dates
Last Update Posted: November 3, 2020
Last Verified: September 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Peter Hutchinson, University of Cambridge:
Phenytoin
Levetiracetam
Post-traumatic seizure
Traumatic brain injury
Additional relevant MeSH terms:
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Brain Injuries
Brain Injuries, Traumatic
Wounds and Injuries
Brain Diseases
Craniocerebral Trauma
Trauma, Nervous System
Seizures
Central Nervous System Diseases
Nervous System Diseases
Neurologic Manifestations
Phenytoin
Levetiracetam
Anticonvulsants
Nootropic Agents
Voltage-Gated Sodium Channel Blockers
Sodium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Cytochrome P-450 CYP1A2 Inducers
Cytochrome P-450 Enzyme Inducers