Investigate Efficacy and Safety of Carisbamate as Adjunctive Treatment for Seizures Associated With LGS in Children and Adults
Seizures, Lennox Gastaut Syndrome
About this trial
This is an interventional treatment trial for Seizures focused on measuring Seizures, Lennox Gastaut Syndrome, Pediatrics, Adults
Eligibility Criteria
Inclusion Criteria:
Subject must have a documented history of Lennox-Gastaut syndrome by:
- Evidence of more than one type of seizure, of which at least one should be an atonic or tonic seizure
- History of an electroencephalogram (EEG) reporting diagnostic criteria for LGS (abnormal background activity accompanied by slow, spike and wave pattern <3.0 Hz)
- History of developmental delay
- Male or female subjects
- Subjects must be age 4-55 years at the time of consent/assent
- Must have been <11 years old at the onset of LGS
- Subjects must have experienced at least 2 drop seizures with potential to fall (tonic, atonic, tonic-clonic) each week during the 4-week Baseline period preceding randomization. Drop seizures are defined as a seizure involving the entire body, trunk, or head that led or could have led to a fall, injury, slumping in a chair, or hitting the subject's head on a surface. For seizures that occur in clusters: if countable, an exact seizure count should be used; if uncountable, the caregiver should estimate the number of seizures.
- Subjects must have been receiving 1 to 4 concomitant anti-seizure medications (ASMs) at a stable dose for at least 4 weeks before Visit 1
- If not taking Epidiolex, subjects may take other approved cannabidiol or over the counter cannabidiol products. If taking cannabidiol other than Epidiolex, consult Medical Monitor to determine if it counts as a concomitant ASM.
- Dietary therapy and any CNS stimulator settings must be stable for 4 weeks prior to baseline and maintain stable regimen throughout the study. The dietary therapy and CNS stimulators are not counted as an ASM.
- Parents or caregivers must be able to keep accurate seizure diaries
- Subject is either not of childbearing potential, defined as premenarchal, postmenopausal for at least 1 year or surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or hysterectomy), if of childbearing potential, must comply with an acceptable method of birth control during the study, for at least 4 weeks prior to study entry and for 4 weeks following completion of the study, if able.
- Subject and/or parent(s)/legal representative must be willing and able to give informed assent/consent for participation in the study
- Subject and their caregiver must be willing and able (in the investigator's opinion) to comply with all study requirements
- History of COVID-19 vaccination is permitted
Exclusion Criteria:
- Etiology of subject's seizures is a progressive neurologic disease. Subjects with tuberous sclerosis will not be excluded from study participation, unless there is a progressive brain tumor
- Evidence of clinically significant disease (e.g., cardiac, respiratory, gastrointestinal, renal disease, hepatic disease) that in the opinion of the investigator(s) could affect the subject's safety or study conduct
- Subjects who were on adrenocorticotropic hormone (ACTH) therapy in the 6 months prior to baseline
- Subject on dietary therapy for less than 4 weeks prior to screening visit (Visit 1) or suffers from frequent stooling
- Current use of felbamate with less than 18 months of continuous exposure
- Concomitant use of vigabatrin: subjects who took vigabatrin in the past must be discontinued for at least 5 months before Visit 1 and must have documentation showing no evidence of a vigabatrin-associated clinically significant abnormality in an automated visual perimetry test, if able.
- Subject who had a history of hypoxia which needed emergency resuscitation within 12 months prior to baseline
- Status epilepticus within 12 weeks of Visit 1
- Any clinically significant illness (including COVID-19) in the 4 weeks prior to Visit 1, as determined by the Investigator
- Subject has clinically significant abnormal laboratory values, in the investigator's opinion, at Visit 1 or time of randomization (Visit 2)
- Subject has a history of any serious drug-induced hypersensitivity, e.g., toxic epidermal necrolysis, or Drug Reaction with Eosinophilia and Systemic Symptoms [DRESS]) or any drug-related rash requiring hospitalization
- Vagus Nerve Stimulation (VNS), Deep Brain Stimulation (DBS), Responsive Neurostimulator System (RNS) or other neurostimulation for epilepsy device implanted or activated <5 months year prior to enrollment. Stimulation parameters that have been stable for <4 weeks, or Battery life of unit not anticipated to extend for duration of trial.
- Subject is pregnant, may be pregnant, lactating or planning to be pregnant
- Any suicidal ideation with intent, with or without a plan within 6 months before Visit 2 (i.e., answering "Yes" to questions 4 or 5 in the Suicidal Ideation section of the age- specific Columbia-Suicide Severity Rating Scale (C-SSRS) in subjects aged 6 and above who are able to be evaluated
- Any suicidal behavior within 2 years before Visit 2 (i.e., answering YES to any question in the Suicidal behavior section of the age-specific Columbia-Suicide Severity Rating Scale (C-SSRS) in subjects aged 6 and above who are able to be evaluated.
- Evidence of significant active hepatic disease. Stable elevations of liver enzymes (alanine aminotransferase (ALT), and aspartate aminotransferase (AST)) due to concomitant medication(s) will be allowed if they are <3 x ULN
- Subject with total bilirubin [TBL] >2 x ULN (except for Gilbert's syndrome).
- Active viral hepatitis (B or C) as demonstrated by positive serology at the Screening visit (Visit 1)
- History of positive antibody/antigen test for human immunodeficiency virus (HIV)
- If taking Epidiolex, subject may not use other approved cannabidiol or over the counter cannabidiol products
- Scheduled for epilepsy-related surgery, VNS insertion, or any other stimulators/surgery during the projected course of the study
- Subject who has taken or used any investigational drug or device in the 4 weeks prior to the screening visit (Visit 1)
- Concomitant use of medications known to be strong inducers of cytochrome P450 (CYP3A) including, but not limited to: phenobarbital, phenytoin, carbamazepine, primidone, rifampin, troglitazone, St. John's Wort, efavirenz, nevirapine, glucocorticoids (other than topical usage), modafinil, pioglitazone, and rifabutin
- Evidence of cardiac disease, including unstable angina, myocardial infarction, within the past 2 years, uncontrolled heart failure, major arrhythmias, congenital short QT syndrome
- Subject with a short QTc interval (<340 msec) or long QTc interval (>460 msec) as confirmed by a repeated electrocardiogram (ECG)
- Benzodiazepine rescue administered on average more than once a week in the month before Visit 1
- Previous exposure to carisbamate or sensitivity/allergy to components of the oral suspension.
Sites / Locations
- Stanford University HospitalRecruiting
- University of Florida Health Science CenterRecruiting
- Pediatric Epilepsy and Neurology SpecialistsRecruiting
- University of South FloridaRecruiting
- Axcess Medical ResearchRecruiting
- Consultants in Epilepsy and Neurology PLLCRecruiting
- Bluegrass Epilepsy Research, LLCRecruiting
- University Medical Center New OrleansRecruiting
- Johns Hopkins HospitalRecruiting
- Mid-Atlantic Epilepsy and Sleep CenterRecruiting
- Mayo ClinicRecruiting
- University of Missouri School of MedicineRecruiting
- Northeast Regional Epilepsy GroupRecruiting
- St. Peters HospitalRecruiting
- MontefioreRecruiting
- Duke University Clinical Research at Pickett RoadRecruiting
- Wake Forest University - School of MedicineRecruiting
- Austin Epilepsy Care Center - Clinic/Outpatient FacilityRecruiting
- Neurology Consultants of Dallas, PA - HospitalRecruiting
- Virginia Epilepsy and Neurodevelopmental Clinic at WNCRecruiting
- Hospital de Ninos de La Santisma TrinidadRecruiting
- Resolution Psychopharmacology Research InstituteRecruiting
- Fundacion Hospital Universidad del Norte
- Fundacion Valle del Lili/Clinic - Outpatient
- CliniSalud del Sur S.A.S - Centro de InvestigaciónRecruiting
- Hospital Pabloe Tubon Uribe
- Institutio Neurologico de ColombiaRecruiting
- Universitatsklinikum ErangenRecruiting
- Kleinwachau Sächsisches EpilepsiezentrumRecruiting
- Iaso Children's HospitalRecruiting
- Tela Viv Sourlasky Medical CenterRecruiting
- Soroka University Medical CentreRecruiting
- Hadassah Medical CenterRecruiting
- Sheba Medical CenterRecruiting
- Istituto G Gaslini Ospedale Pediatrico IRCCS - INCIPIT - PINRecruiting
- ASST Fatebenefratelli Sacco - Ospedale dei Bambini Vittore BuzziRecruiting
- Fondazione IRCCS Di Rilievo Nazionale InstitutoRecruiting
- Azienda Ospedaliera Universitaria Integrata Di VeronaRecruiting
- Kyungpook National University Chilgok HospitalRecruiting
- Samsung Medical CenterRecruiting
- Seoul National University HospitalRecruiting
- Hospital Civil Fray Antonio AlcaldeRecruiting
- Neurociencias Estudios Clinicos S.C.Recruiting
- Clinstile, S.A. de C.V.Recruiting
- Szpital Kliniczny im.H.Swiecickiego Uniwersytetu Medycznego im.K.Marcinkowskiego w Poznaniu-Dluga1/2Recruiting
- Centrum Medyczne PlejadyRecruiting
- Hospital Garcia de OrtaRecruiting
- Centro Hospitalar de Lisboa Norte, EPERecruiting
- Centro Hospitalar de Lisboa Ocidental, EPE - Hospital Sao Francisco XavierRecruiting
- Centro Hospitalar de Sao Joao, EPERecruiting
- Childrens University HospitalRecruiting
- University Clinical Center KragujevacRecruiting
- University Clinical Center NisRecruiting
- Hospital Sant Joan de Deu - PINRecruiting
- Hospital Infantil Universitario Niño Jesus - PINRecruiting
- Hospital Ruber Internacional (Grupo Quironsalud)Recruiting
- National Taiwan University HospitalRecruiting
- Taipei Veterans General HospitalRecruiting
- Chang Gung Memorial HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Experimental
Placebo Comparator
Placebo Comparator
Carisbamate 200 mg BID arm
Carisbamate 300 mg BID arm
Placebo matched to 200 mg BID arm
Placebo matched to 300 mg BID arm
Age: 4 to <12y* Titration: 2 mg/kg BID Maintenance: 4 mg/kg BID Age: ≥12 y Titration: 100 mg BID Maintenance: 200 mg BID
Age: 4 to <12y* Titration: 2.75 mg/kg BID Maintenance: 5.5 mg/kg BID Age: ≥12 y Titration: 150 mg BID Maintenance: 300 mg BID
Age: 4 to <12y* Titration: Volume equivalent to 2 mg/kg BID Maintenance: Volume equivalent to 4 mg/kg BID Age: ≥12 y Titration: Volume equivalent to 100 mg BID Maintenance: Volume equivalent to 200 mg BID
Age: 4 to <12y* Titration: Volume equivalent to 2.75 mg/kg BID Maintenance: Volume equivalent to 5.5 mg/kg BID Age: ≥12 y Titration: Volume equivalent to 150 mg BID Maintenance: Volume equivalent to 300 mg BID