Clinical Trial : TROCC (Quick Oral Treatment of Cluster Epileptic Seizures)

Rapid Oral Treatment of Cluster Epileptic Seizures. Efficacy Assessment of Levetiracetam in Cluster Seizures.

This is a double blind, placebo controlled, add-on clinical trial, of levetiracetam efficacy and safety, in epilepsy cluster seizure. Efficacy is evaluated in the range of 2 to 24 hours after taking the tablet. If the patient has a seizure during this interval, he is considered as a non-respondent patient.

Seizure clustering has been defined as a series of unusual frequency of seizures with return to baseline between events. The most common definition of cluster seizure is three seizures per 24 hours. The usual treatment of cluster seizure is benzodiazepin. This is recognized efficient therapy but has many side effects. Thus it is important to develop as an new therapeutic to improve patient care. Levetiracetam is an antiepileptic drug used in addition to other antiepileptic drugs with less side effects than benzodiazepin. The aim of this study is to evaluate the effectiveness and safety of levetiracetam in epilepsy cluster seizure. This is a double blind, placebo controlled, add-on clinical trial with two phases : Phase 1 : Double blind phase during 24 hours (H0 to H24). After consent signature and randomization, the patient takes two tablets of levetiracetam or placebo. If the patient has a seizure between H3 and H24, he is considered as a non-respondent patient. If there is a risk of rapid evolution to an statue epilepticus, the investigator can break the blind and adapt the patient treatment accordingly. Phase 2 : This is an open phase after H24. this phase consists of breaking the blind with free adaption of the therapy by the investigator, and patients follow-up during 1 month. The randomization is stratify by center. The size of randomization blocks is random because of the systematic breaking blind after 24 hours.

Cluster seizure, seizure clustering, repetitive seizure, Drug resistant epilepsy, Levetiracetam, keppra

Number of seizures occured between H3 and H10, H10 and H17, H17 and H24, corresponding to the half-time of the treatment (7 hours).

Inclusion Criteria: Age from 18 to 65 Drug resistant epilepsy, partial seizure Epilepsy diagnosed for more than 2 years Epilepsy treated for more than 1 year with no change of treatment in the month before the enrolment Onset of cluster seizure in the 24 hours before enrolment For women : effective contraception Affiliation to the French social security Exclusion Criteria: Inability to tolerate levetiracetam, likely poor compliance Patient taking antiepileptic treatment (benzodiazepine) in addition to current treatment during the last 48h00. Patient taking 1g/day of levetiracetam with Creatinin clearance < 50ml/min Patient taking 2g/day of levetiracetam with Creatinin clearance < 80ml/min Patient taking more than 2g/day of levetiracetam Hepatic or cardiovascular pathology Progressive psychiatric pathology Degenerative neurologic disease Cluster seizure due to an acute symptomatic reason Disorder of consciousness Suspicion of status epilepticus or rapid evolution to status epilepticus Suspicion of psychogenic nonepileptic seizure Pregnant woman or nursing woman Suicidal thoughts Incapacity to give consent, minor patient

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