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TMS Combined With EEG/EMG as a Biomarker Predicting Antiepileptic Drug Response (BIOEPI)

Primary Purpose

Focal Epilepsy

Status
Recruiting
Phase
Not Applicable
Locations
Greece
Study Type
Interventional
Intervention
Software EstimLT
Sponsored by
Aristotle University Of Thessaloniki
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Focal Epilepsy focused on measuring epilepsy, medical device

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

General criteria:

  1. Adult volunteers aged 18-65 years
  2. Able to provide informed consent
  3. Meet the criteria of the attached TMS safety questionnaire (Rossi et al, 2011). It is clarified that: a) criterion 1 does not apply to the group of patients and b) a positive answer to criteria 5, 6, 8, 9 & 10 excludes inclusion in the study while the other answers are evaluated by the investigator.

Specific criteria:

The specific criteria per group of study participants are as follows:

Patient Group:

  1. Adult patients, 18-65 years of age, suffering from focal epilepsy, as evidenced by clinical and EEG features.
  2. All patients continue suffering from seizures despite treatment with 1-2 concomitant AEDs (with vagal nerve stimulation counting as an AED). In order to be eligible, patients should be suffering from simple partial seizures (SPS) and a motor component or complex partial seizures (CPS) with or without secondary generalization (sGS). Patients should report at least three seizures during the 12 weeks of Historical Baseline.
  3. Patients are required to be Lacosamide and Brivaracetam-naive and, in the latter case, not taking concomitant Levetiracetam.
  4. Patients are about to commence treatment with Lacosamide or Brivaracetam, as per the treating physician's orders. It is stressed that the decision to prescribe Lacosamide or Brivaracetam is made by the patient's treating physician totally independently from participation in the current study.
  5. Epilepsies of genetic or unknown aetiology (patients with hippocampal sclerosis can be included). The epileptic patients will be a convenience sample recruited at the Epilepsy Outpatient Clinic of the University General Hospital of Thessaloniki "AHEPA".

Healthy control group:

Adult, healthy volunteers, 18-65 years of age

Exclusion Criteria:

The specific criteria per group of study participants are as follows:

Patient Group:

  1. The presence of Central Nervous System "CNS" disorders other than epilepsy on history or examination
  2. Comorbid psychiatric or medical conditions that may compromise the ability of the individuals to participate in the study
  3. EEG evidence of generalized epilepsy.
  4. Uncountable seizures due to clustering.
  5. Use of centrally acting drugs other than AEDs.
  6. Pregnancy or planned pregnancy prior to the index test.

Healthy control group:

  1. Presence of medical or psychiatric conditions that may interfere with the procedures.
  2. Contraindications to TMS (i.e. pregnancy, presence of heart pacemakers, metal objects etc).
  3. History of adverse reactions to pharmacological agents.
  4. History of alcohol or nicotine abuse or use of any other centrally acting drug.
  5. Participation in another clinical trial in the previous 8 weeks.
  6. Pregnancy or planned pregnancy prior to the index test.

Sites / Locations

  • Prof. Vasilios KimiskidisRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Healthy volunteers

Patients with focal epilepsy

Arm Description

Each healthy volunteer during Part I of the study will receive every 2 weeks a single per os dose of Lacosamide (200 mg), Brivaracetam (50 mg) or placebo. All healthy volunteers will perform tests using the new software that combines Transcranial Magnetic Stimulation Combined With EEG/EMG,

Patients during Part II, will receive the treatment according to the treating physician's discretion, regardless of the protocol, either with Lacosamide, 300 mg p.o. or Brivaracetam, 100 mg p.o. All patients will perform tests using the new software that combines Transcranial Magnetic Stimulation Combined With EEG/EMG,

Outcomes

Primary Outcome Measures

Diagnostic accuracy of TMS Combined With EEG/EMG for predicting response to AEDs
The Primary Outcome Measure is the diagnostic accuracy (calculated as the number of true positives + true negatives)/(number of true positives + true negatives + false positives + false negatives) of the index test for predicting response to AEDs (defined as reduction of seizure frequency by 50% or more during the maintenance period in comparison to baseline). The primary efficacy endpoint will be assessed in the combined groups of responders (LAC+BRV) and non-responders (LAC+BRV) because the starting hypothesis is that response to AEDs will be associated with alterations in TMS-EEG/EMG biomarkers.

Secondary Outcome Measures

PPV, NPV, LR+ & LR- of TMS Combined With EEG/EMG for predicting response to AEDs
Positive Predictive Value (PPV), Negative Predictive Value (NPV), positive likelihood ratio (LR+) & negative likelihood ratio (LR-) of TMS Combined With EEG/EMG for predicting response to AEDs (defined as reduction of seizure frequency by 50% or more).
Accuracy, PPV, NPV, LR+ & LR- of TMS Combined With EEG/EMG for other measures of response to AEDs
Accuracy, PPV, NPV, positive likelihood ratio (LR+) & negative likelihood ratio (LR-) of TMS Combined With EEG/EMG for other measures of response to AEDs (i.e. percent seizure reduction, seizure freedom, time to n th (n=1,5th,10th) seizure).
Accuracy of TMS Combined With EEG/EMG for predicting AED-induced side-effects
Accuracy of TMS Combined With EEG/EMG for predicting AED-induced cognitive side-effects and other study-emergent Adverse Events

Full Information

First Posted
February 10, 2022
Last Updated
March 9, 2023
Sponsor
Aristotle University Of Thessaloniki
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1. Study Identification

Unique Protocol Identification Number
NCT05278221
Brief Title
TMS Combined With EEG/EMG as a Biomarker Predicting Antiepileptic Drug Response
Acronym
BIOEPI
Official Title
Development and Optimization of Transcranial Magnetic Stimulation (TMS) Combined With EEG/EMG as a Biomarker Predicting Response to Antiepileptic Drugs
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 1, 2022 (Actual)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
March 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Aristotle University Of Thessaloniki

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Ιn the present study (BIOEPI), the following three hypotheses will be investigated: The proposed TMS-EEG / EMG protocol (which includes software for calculating the cerebral cortex stimulation threshold) in combination with advanced signal analysis and data mining methods will allow the detection of the effect of antiepileptic drugs (AED) with different mechanisms of action (lacosamide & brivaracetam) in the Central Nervous System under healthy and pathological conditions (Epilepsy). AED-induced changes in selected TMS-EEG / EMG features predict the clinical response of individual epileptic patients to AED. AED-induced changes in selected TMS-EEG / EMG features may predict cognitive side effects.
Detailed Description
The overarching objective of this study is to develop a combined TMS-EEG/EMG protocol so as to explore the effects of AEDs on cortical excitability and obtain novel electrophysiological biomarkers which could help predict the response of epileptic patients to AEDs, in line with the principles of personalized medicine. In order to achieve the overarching objective, we will perform a Diagnostic Clinical Performance Study, (FDA 2013) with the following specific objectives. Primary Objective 1: To investigate whether TMS-EEG/EMG biomarkers can predict the response of patients with focal epilepsy to AEDs (Lacosamide & Brivaracetam). Secondary Objective 1: Development, testing and validation of novel TMS-EEG/EMG stimulation and multi-level data analysis protocols, incorporating advanced methods of signal analysis, connectivity, complexity, and propagation across the cortical mantle. Secondary Objective 2: Investigating the sensitivity of TMS-EEG/EMG biomarkers for detecting changes in brain physiology in healthy subjects and patients with focal epilepsy.Secondary Objective 3: Investigating whether TMS-EEG / EMG biomarkers may predict cognitive deficits in patients with focal epilepsy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Focal Epilepsy
Keywords
epilepsy, medical device

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
The study has 2 parts; part I that includes healthy volunteers and part II that includes patients with focal epilepsy. Each healthy volunteer will participate in three sessions every 2 weeks and will receive a single per os dose of Lacosamide (200 mg), Brivaracetam (50 mg) or placebo. Patients in part II will receive either Lacosamide, 300 mg p.o. or Brivaracetam, 100 mg p.o. All participants will perform a test using the tested software that combines a Transcranial Magnetic Stimulation with EEG/EMG
Masking
Outcomes Assessor
Masking Description
The evaluator of the outcomes will be blinded
Allocation
Non-Randomized
Enrollment
42 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Healthy volunteers
Arm Type
Other
Arm Description
Each healthy volunteer during Part I of the study will receive every 2 weeks a single per os dose of Lacosamide (200 mg), Brivaracetam (50 mg) or placebo. All healthy volunteers will perform tests using the new software that combines Transcranial Magnetic Stimulation Combined With EEG/EMG,
Arm Title
Patients with focal epilepsy
Arm Type
Other
Arm Description
Patients during Part II, will receive the treatment according to the treating physician's discretion, regardless of the protocol, either with Lacosamide, 300 mg p.o. or Brivaracetam, 100 mg p.o. All patients will perform tests using the new software that combines Transcranial Magnetic Stimulation Combined With EEG/EMG,
Intervention Type
Device
Intervention Name(s)
Software EstimLT
Intervention Description
Healthy volunteers will receive a single per os dose of Lacosamide (200 mg), Brivaracetam (50 mg) or placebo and then the software will be tested
Primary Outcome Measure Information:
Title
Diagnostic accuracy of TMS Combined With EEG/EMG for predicting response to AEDs
Description
The Primary Outcome Measure is the diagnostic accuracy (calculated as the number of true positives + true negatives)/(number of true positives + true negatives + false positives + false negatives) of the index test for predicting response to AEDs (defined as reduction of seizure frequency by 50% or more during the maintenance period in comparison to baseline). The primary efficacy endpoint will be assessed in the combined groups of responders (LAC+BRV) and non-responders (LAC+BRV) because the starting hypothesis is that response to AEDs will be associated with alterations in TMS-EEG/EMG biomarkers.
Time Frame
9 months
Secondary Outcome Measure Information:
Title
PPV, NPV, LR+ & LR- of TMS Combined With EEG/EMG for predicting response to AEDs
Description
Positive Predictive Value (PPV), Negative Predictive Value (NPV), positive likelihood ratio (LR+) & negative likelihood ratio (LR-) of TMS Combined With EEG/EMG for predicting response to AEDs (defined as reduction of seizure frequency by 50% or more).
Time Frame
Through study completion, an average of 2 years
Title
Accuracy, PPV, NPV, LR+ & LR- of TMS Combined With EEG/EMG for other measures of response to AEDs
Description
Accuracy, PPV, NPV, positive likelihood ratio (LR+) & negative likelihood ratio (LR-) of TMS Combined With EEG/EMG for other measures of response to AEDs (i.e. percent seizure reduction, seizure freedom, time to n th (n=1,5th,10th) seizure).
Time Frame
Through study completion, an average of 2 years
Title
Accuracy of TMS Combined With EEG/EMG for predicting AED-induced side-effects
Description
Accuracy of TMS Combined With EEG/EMG for predicting AED-induced cognitive side-effects and other study-emergent Adverse Events
Time Frame
Through study completion, an average of 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: General criteria: Adult volunteers aged 18-65 years Able to provide informed consent Meet the criteria of the attached TMS safety questionnaire (Rossi et al, 2011). It is clarified that: a) criterion 1 does not apply to the group of patients and b) a positive answer to criteria 5, 6, 8, 9 & 10 excludes inclusion in the study while the other answers are evaluated by the investigator. Specific criteria: The specific criteria per group of study participants are as follows: Patient Group: Adult patients, 18-65 years of age, suffering from focal epilepsy, as evidenced by clinical and EEG features. All patients continue suffering from seizures despite treatment with 1-2 concomitant AEDs (with vagal nerve stimulation counting as an AED). In order to be eligible, patients should be suffering from simple partial seizures (SPS) and a motor component or complex partial seizures (CPS) with or without secondary generalization (sGS). Patients should report at least three seizures during the 12 weeks of Historical Baseline. Patients are required to be Lacosamide and Brivaracetam-naive and, in the latter case, not taking concomitant Levetiracetam. Patients are about to commence treatment with Lacosamide or Brivaracetam, as per the treating physician's orders. It is stressed that the decision to prescribe Lacosamide or Brivaracetam is made by the patient's treating physician totally independently from participation in the current study. Epilepsies of genetic or unknown aetiology (patients with hippocampal sclerosis can be included). The epileptic patients will be a convenience sample recruited at the Epilepsy Outpatient Clinic of the University General Hospital of Thessaloniki "AHEPA". Healthy control group: Adult, healthy volunteers, 18-65 years of age Exclusion Criteria: The specific criteria per group of study participants are as follows: Patient Group: The presence of Central Nervous System "CNS" disorders other than epilepsy on history or examination Comorbid psychiatric or medical conditions that may compromise the ability of the individuals to participate in the study EEG evidence of generalized epilepsy. Uncountable seizures due to clustering. Use of centrally acting drugs other than AEDs. Pregnancy or planned pregnancy prior to the index test. Healthy control group: Presence of medical or psychiatric conditions that may interfere with the procedures. Contraindications to TMS (i.e. pregnancy, presence of heart pacemakers, metal objects etc). History of adverse reactions to pharmacological agents. History of alcohol or nicotine abuse or use of any other centrally acting drug. Participation in another clinical trial in the previous 8 weeks. Pregnancy or planned pregnancy prior to the index test.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Vasilios Kimiskidis, Professor
Phone
+30-2310-994667
Email
kimiskid@auth.gr
Facility Information:
Facility Name
Prof. Vasilios Kimiskidis
City
Thessaloníki
State/Province
Thessaloniki
ZIP/Postal Code
546 36
Country
Greece
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Vasilios Kimiskidis
Phone
0030 2310 994667
Email
kimiskid@auth.gr

12. IPD Sharing Statement

Plan to Share IPD
No

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TMS Combined With EEG/EMG as a Biomarker Predicting Antiepileptic Drug Response

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