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Children's Adaptive Deep Brain Stimulation for Epilepsy Trial (CADET): Pilot (CADET Pilot)

Primary Purpose

Epilepsy, Lennox-Gastaut Syndrome, Intractable

Status
Recruiting
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
Deep brain stimulation
Sponsored by
University College, London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional device feasibility trial for Epilepsy focused on measuring Deep brain stimulation, Neurostimulation, Neuromodulation, Epilepsy, Lennox-Gastaut Syndrome

Eligibility Criteria

5 Years - 14 Years (Child)All SexesDoes not accept healthy volunteers

INCLUSION CRITERIA:

Children enrolled in this study must:

  1. Be 5-15 years of age at consent.
  2. Have a diagnosis of Lennox-Gastaut Syndrome, as determined by:

    • Slow (<3.0Hz) spike-and-wave pattern and/or fast wave pattern (tonic seizures) on EEG for at least six-months months prior to the enrolment into the baseline period
    • History of drop seizures (tonic, atonic, or tonic-clonic) for at least six-months prior to the enrolment into the baseline period
  3. Experience at least 10 seizures per month.
  4. Have tried and not responded to two or more antiseizure medications prior to enrolment.
  5. Be taking one or more anti-seizure medication(s) at a stable dose for at least the four weeks prior and have a parent/guardian(s) who is willing for their child's maintenance anti-seizure drugs to be unaltered for the trial duration.
  6. If on a ketogenic diet, have been established on a stable ketogenic diet for at least 12 weeks prior to screening and the parent/guardian(s) to be willing for child to stay on a stable ketogenic for the duration of the trial.
  7. Have a parent/guardian(s) who is willing and able to comply with all the requirements of the study, including the completion of the seizure diary and periodic device charging.

    -------------------------------

EXCLUSION CRITERIA:

Children enrolled in this study must not have:

  1. Prior deep brain stimulation insertion.
  2. An active ('on') vagus nerve stimulator (or active within the six months prior to the baseline period).
  3. Abnormal thalamic anatomy detected on imaging that would render DBS either unsafe or unfeasible.
  4. Bleeding disorders.
  5. Medical conditions/factors that would increase their anaesthetic risk to an unacceptable level.
  6. Nickel allergy

Sites / Locations

  • Great Ormond Street Hospital NHS Foundation TrustRecruiting
  • King's College Hospital NHS Foundation Trust

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Deep brain stimulation

Arm Description

Deep Brain stimulation using a novel device: Bioinduction "Picostim" Deep Brain Stimulation system.

Outcomes

Primary Outcome Measures

Adverse evens
Measured according to pre-determined device-related AEs and SAEs, as well as generic AEs and SAEs.
Willingness of the participants/parents/guardians for the participant to be recruited into the study and to undergo the intervention
Consent at baseline
Participant completion of the study
Completion of all study activities at study exit
Ability of the participant/parent(s)/guardian(s) to re-charge and maintain the device
Device recharging is measured using the Picostim event logs

Secondary Outcome Measures

Relative change in parent-reported seizure frequency
Measured using parent-reported diaries
Relative change in electrographic-recorded seizure frequency
Measured using serial electroencephalography (EEG)
Relative change in seizure severity
Measured using the Hague Seizure Severity Scoring questionnaire. Minimum score = 13; maximum score = 52; with higher seizure severity with ascending values.
Relative change in quality of life
Measured on the Pediatric Quality of Life Inventory (PedsQL) questionnaire. The minimum score is 0 and the maximum score is 100, with improving quality of life with ascending values.
Relative change in quality of life
Measured on the Impact of Pediatric Epilepsy Scale (IPES) questionnaires. The minimum score is 0 and the maximum score is 100, with improving quality of life with ascending values.

Full Information

First Posted
June 20, 2022
Last Updated
June 5, 2023
Sponsor
University College, London
Collaborators
Great Ormond Street Hospital for Children NHS Foundation Trust, King's College Hospital NHS Trust, University of Oxford, King's College London
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1. Study Identification

Unique Protocol Identification Number
NCT05437393
Brief Title
Children's Adaptive Deep Brain Stimulation for Epilepsy Trial (CADET): Pilot
Acronym
CADET Pilot
Official Title
Children's Adaptive Deep Brain Stimulation for Epilepsy Trial (CADET): Pilot
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 2, 2023 (Actual)
Primary Completion Date
July 31, 2024 (Anticipated)
Study Completion Date
July 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University College, London
Collaborators
Great Ormond Street Hospital for Children NHS Foundation Trust, King's College Hospital NHS Trust, University of Oxford, King's College London

4. Oversight

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

5. Study Description

Brief Summary
The CADET Pilot will investigate the safety and feasibility of deep brain stimulation (DBS) to treat children with Lennox-Gastaut syndrome using a novel DBS device (Picostim DyNeuMo-1). Following a 30-day preoperative/baseline assessment phase, all children will have a neurosurgical procedure to implant the device. Implantation will be followed by a 30-day phase of no stimulation (the device is off / inactive) and then a six-month phase of active stimulation (the device is on / active).
Detailed Description
The CADET pilot will be a single-arm, multi-site, interventional clinical trial. This design has been chosen since this is a feasibility and safety trial in a small number of patients and thus does not primarily aim to determine efficacy. In this pilot clinical trial, four children with drug-resistant LGS will undergo bilateral CMN DBS. Following the DBS insertion, all children will undergo one month of inactive ('off') DBS in order to allow the lesioning effect of electrode implantation to dissipate. Thereafter, children will receive active ('on') DBS therapy with standard stimulation parameters for six-months. Following the 'on' phase of the trial, the child will then transition into continuing clinical care and will have their stimulation parameters altered according to clinical evaluation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Epilepsy, Lennox-Gastaut Syndrome, Intractable
Keywords
Deep brain stimulation, Neurostimulation, Neuromodulation, Epilepsy, Lennox-Gastaut Syndrome

7. Study Design

Primary Purpose
Device Feasibility
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
4 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Deep brain stimulation
Arm Type
Experimental
Arm Description
Deep Brain stimulation using a novel device: Bioinduction "Picostim" Deep Brain Stimulation system.
Intervention Type
Device
Intervention Name(s)
Deep brain stimulation
Intervention Description
Deep brain stimulation of the centromedian nucleus (bilateral)
Primary Outcome Measure Information:
Title
Adverse evens
Description
Measured according to pre-determined device-related AEs and SAEs, as well as generic AEs and SAEs.
Time Frame
Following 6-months of active stimulation
Title
Willingness of the participants/parents/guardians for the participant to be recruited into the study and to undergo the intervention
Description
Consent at baseline
Time Frame
Following 6-months of active stimulation
Title
Participant completion of the study
Description
Completion of all study activities at study exit
Time Frame
Following 6-months of active stimulation
Title
Ability of the participant/parent(s)/guardian(s) to re-charge and maintain the device
Description
Device recharging is measured using the Picostim event logs
Time Frame
Following 6-months of active stimulation
Secondary Outcome Measure Information:
Title
Relative change in parent-reported seizure frequency
Description
Measured using parent-reported diaries
Time Frame
Following 6-months of active stimulation (compared to baseline)
Title
Relative change in electrographic-recorded seizure frequency
Description
Measured using serial electroencephalography (EEG)
Time Frame
Following 6-months of active stimulation (compared to baseline)
Title
Relative change in seizure severity
Description
Measured using the Hague Seizure Severity Scoring questionnaire. Minimum score = 13; maximum score = 52; with higher seizure severity with ascending values.
Time Frame
Following 6-months of active stimulation (compared to baseline)
Title
Relative change in quality of life
Description
Measured on the Pediatric Quality of Life Inventory (PedsQL) questionnaire. The minimum score is 0 and the maximum score is 100, with improving quality of life with ascending values.
Time Frame
Following 6-months of active stimulation (compared to baseline)
Title
Relative change in quality of life
Description
Measured on the Impact of Pediatric Epilepsy Scale (IPES) questionnaires. The minimum score is 0 and the maximum score is 100, with improving quality of life with ascending values.
Time Frame
Following 6-months of active stimulation (compared to baseline)
Other Pre-specified Outcome Measures:
Title
Radiological correlates of neurophysiological and clinical response to CMN DBS
Description
Analysis of pre-trial MRI brain scan in conjunction with relative change in seizure counts measured using parent-reported diaries
Time Frame
Following 6-months of active stimulation
Title
Correlates of the scalp EEG with the intracranial recordings (local field potentials) from the DBS device.
Description
Analysis of local-field potentials measured from the DBS device in conjunction with data from the encephalography (EEG) data
Time Frame
Following 6-months of active stimulation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Maximum Age & Unit of Time
14 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Children enrolled in this study must: Be 5-14 years of age at consent. Have a diagnosis of Lennox-Gastaut Syndrome, as determined by: Slow (<3.0Hz) spike-and-wave pattern and/or fast wave pattern (tonic seizures) on EEG for at least six-months months prior to the enrolment into the baseline period History of drop seizures (tonic, atonic, or tonic-clonic) for at least six-months prior to the enrolment into the baseline period Experience at least 10 seizures per month. Have tried and not responded to two or more antiseizure medications prior to enrolment. Be taking one or more anti-seizure medication(s) at a stable dose for at least the four weeks prior and have a parent/guardian(s) who is willing for their child's maintenance anti-seizure drugs to be unaltered for the trial duration. If on a ketogenic diet, have been established on a stable ketogenic diet for at least 12 weeks prior to screening and the parent/guardian(s) to be willing for child to stay on a stable ketogenic for the duration of the trial. Have a parent/guardian(s) who is willing and able to comply with all the requirements of the study, including the completion of the seizure diary and periodic device charging. ------------------------------- EXCLUSION CRITERIA: Children enrolled in this study must not: Have had prior deep brain stimulation insertion. Have an active ('on') vagus nerve stimulator (or active within the six months prior to the baseline period). Have abnormal thalamic anatomy detected on imaging that would render DBS either unsafe or unfeasible. Have a bleeding disorder. Have medical conditions/factors that would increase their anaesthetic risk to an unacceptable level. Have a nickel allergy Be pregnant Participate in contact sports
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Rory J Piper, MRCS
Phone
20 7405 9200
Email
rory.piper.20@ucl.ac.uk
First Name & Middle Initial & Last Name or Official Title & Degree
Martin M Tisdall, FRCS
Phone
20 7405 9200
Email
m.tisdall@ucl.ac.uk
Facility Information:
Facility Name
Great Ormond Street Hospital NHS Foundation Trust
City
London
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rory Piper, MRCS
First Name & Middle Initial & Last Name & Degree
Martin Tisdall, FRCS
Facility Name
King's College Hospital NHS Foundation Trust
City
London
Country
United Kingdom
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Antonio Valentin, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

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Children's Adaptive Deep Brain Stimulation for Epilepsy Trial (CADET): Pilot

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