AzTrials
AzTrials

Afebrile Seizure (Finding)CASToxNCT03310697

Toxicological Screening by GC-MS Among Children Admitted for a First Afebrile Seizure

A study testing Collection of blood and urine samples and Clinical examination in people with Afebrile Seizure (Finding), run by University Hospital, Toulouse at 1 site in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Before the age of 14 years, 1% of the paediatric population will develop a seizure. The only systematically required complementary examination is an electroencephalogram (EEG). Additional biological or radiological examinations depend on the circumstances, the past medical history of the patient and other associated… Read more about this study

Who is it for?
Ages 1 month to 15 years
Conditions the study is for
Afebrile Seizure (Finding)
What is being tested?
Collection of blood and urine samples and Clinical examination
Could I receive a placebo?
No, everyone receives an active treatment
How many people
48 participants
Where
1 siteFrance
Study dates
19 Dec 2017to 6 Oct 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 month to 15 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Being aged between 1 month and 15 years for boys and 1 month and 11 years for girls
  • Any first episode of afebrile seizure, independent of duration, type (generalized or not) occurring in children without any previous neurological history and admitted to Toulouse level III paediatric emergency unit (University Children Hospital, Toulouse)
  • Consent form signed by parents or legal guardian

Who cannot join

  • Patient transferred from another hospital
  • Absence of consent form signed by parents or legal guardian
  • Seizure in a febrile context at the moment of inclusion
  • Known history of neurological disorders
  • Any kind of diagnosed epilepsy
  • Renal or hepatocellular insufficiency
Show all 9Show fewer
  • Recent head trauma
  • Coagulation disorders (hemophilia, secondary or primary thrombopenia)
  • Known exposure to toxic molecules

Trial locations and contacts

1 site in 1 country.

France1 site
  • Hôpital des enfants

    Toulouse, Midi-Pyrénées, 31059

Other trials in France

About this study

Official title: Toxicological Screening by GC-MS Among Children Admitted for a First Afebrile Seizure (CASTox): a Pilot Study

Before the age of 14 years, 1% of the paediatric population will develop a seizure. The only systematically required complementary examination is an electroencephalogram (EEG). Additional biological or radiological examinations depend on the circumstances, the past medical history of the patient and other associated symptoms or clinical signs. A seizure can be the first sign of acute intoxication and represents a severity criterion. Failure to detect the toxic cause of a seizure can lead to a delay in the access or administration of an antidote if applicable. This can lead to target organ toxicity due to the absence of specific treatment. In the current French guidelines for a first seizure, a toxicological analysis is recommended if there is a possibility of exposure to toxic medications or products. However, this screening is often missing, unless a witness suggests that the child may have been exposed to a toxin.The recognition of a paediatric toxidrome is low among paediatricians, paediatric neurologists or emergency physicians. This is due to a lack of knowledge in clinical toxicology and the screening for toxic aetiology is not frequently or irrelevantly prescribed. There is an increasing number of proconvulsive molecules on the market. These molecules are not targeted in classic toxic screening. As result, a toxic cause of a seizure may be missed unless specific screening is performed. For all these reasons, little is known about the prevalence of toxic causes after a first episode of non-febrile seizure and probably under estimated in the paediatric population, especially in young children. New technologies for toxic detection like chromatography combined with mass spectrometry allow wide screening on different matrix. Initially dedicated to forensic analysis, they are more widely accessible for the exploration of the patients. The CASTox study is based on this context.

The first aim will be to evaluate the prevalence of a toxicological cause by a systematic blood and urine screening of children admitted to Toulouse paediatric emergency unit for a first afebrile seizure. Moreover, secondary aim will be to describe the effect of the systematic screening on the management of the children.

Read the detailed description

Before the age of 14 years, 1% of the paediatric population will develop a seizure. The only systematically required complementary examination is an electroencephalogram (EEG). Additional biological or radiological examinations depend on the circumstances, the past medical history of the patient and other associated symptoms or clinical signs. A seizure can be the first sign of acute intoxication and represents a severity criterion. Failure to detect the toxic cause of a seizure can lead to a delay in the access or administration of an antidote if applicable. This can lead to target organ toxicity due to the absence of specific treatment. In the current French guidelines for a first seizure, a toxicological analysis is recommended if there is a possibility of exposure to toxic medications or products. However, this screening is often missing, unless a witness suggests that the child may have been exposed to a toxin.The recognition of a paediatric toxidrome is low among paediatricians, paediatric neurologists or emergency physicians. Since the end of the 90s, the molecules usually incriminated with seizure onset after intoxication are: with a high risk (polycyclic antidepressant, theophylline, isoniazid); intermediate risk (fluoroquinolones, tramadol, lidocaine, lithium, anticonvulsive medications) and low risk (selective serotonin reuptake inhibitors). Among infants, the molecules are quite different mainly because of the unintentional or malicious aspect of the intoxication and are dominated by sympathomimetic agents, antihistamine drugs, anticholinergic molecules, antidepressants and muscle relaxants. New drugs have been associated with seizures in young intoxicated children like bupropion, tramadol and venlafaxine. These agents are not detected by usual toxic analysis.

For each patient and after getting the signed consent form, a toxicological analysis will be performed on blood and urine samples to extensively screen for proconvulsive molecules (alcohols, polycyclic antidepressants, salicylates, anticonvulsive medications (carbamazepine, phenytoin, valproic acid), drugs (cocaine and its metabolites, amphetamines, methamphetamine (ecstasy), cannabis, buprenorphine, methadone, mephedrone, codeine, pholcodine, hydromorphone), benzodiazepines, caffeine, theophylline, lidocaine, isoniazid, mefenamic acid, tramadol, ephedrine).

This analysis will be performed using classic approach (immunoenzymatic detection) and by chromatography (GC) associated to mass spectrometry (MS) (Laboratory of Toxicology, University Hospital of Toulouse) - The other clinical data, biological results or tests requested by the physician in charge will be reported from the computerized medical file of each patient.

For each patient hospitalized, a follow-up visit will be scheduled during hospitalization in order to report management of the children.

Being tested
Collection of blood and urine samples, Clinical examination
Keywords
Afebrile seizure, Toxicological screening, Chromatography, Mass spectrometry, Children
Medical subject headings
Signs and Symptoms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Collection of blood and urine samplesOther

    For each child, a toxicological screening will be carried out on the blood and urine for the research of proconvulsive molecules by conventional technique on the one hand and by gas chromatography coupled with a mass spectrograph on the other hand.

  • Clinical examinationOther

    The other clinical data, any other biological samples or additional examinations are done under the opinion of the clinician or the neuropediatrics.

Study groups in NCT03310697
Study groupRoleWhat they receive
Children with afebrile seizureExperimentalFor each child, a toxicological screening will be carried out on the blood and urine for the research of proconvulsive molecules by conventional technique on the one hand and by gas chromatography coupled with a mass spectrograph on the other hand. Intervention : Collection of blood and urine samples, and Clinical examination
Receives: Other: Collection of blood and urine samples; Other: Clinical examination

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Detection of one or several toxic molecules.

    Analyzed by systematic screening of a blood and urine sample.

    Measured: Day 1

Secondary outcomes (4)
  1. The delay of detection of a cause for a first afebrile seizure in paediatric patients.

    It is the time between the admission to paediatric emergency unit and the detection of the first afebrile seizure's cause for paediatric patients

    Measured: Day 1

  2. The length of stay in Toulouse paediatric emergency unit or in hospitalization.

    Measured: Day 1

  3. number of tests performed in the search of an aetiology

    Measured: Day 1

  4. The number of tests performed in the search of an aetiology.

    Measured: Day 1

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Oct 2017
  2. Study start19 Dec 2017
  3. Primary completion6 Oct 2020
  4. Study completion6 Oct 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Screening
Allocation
Not applicable
Intervention model
Single group
Model description
Transverse prevalence study. For each child, a toxicological screening will be carried out on the blood and urine for the research of proconvulsive molecules by conventional technique on the one hand and by gas chromatography coupled with a mass spectrograph on the other hand.
Masking
None (open label)
Enrolment
48 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03310697
Sponsor's protocol ID
RC31/16/8246
Other IDs
2017-A01319-44
Acronym
CASTox
Status last verified
Oct 2021
First submitted
20 Jul 2017
Last updated
28 Oct 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Bartoli M, Berny C, Danel V, Delahaye A, Desch G, Guitton J, Lacarelle B, Lapostolle F, Mathieu D, Megarbane B, Nisse P, Szymanowicz A, Capolaghi B; Toxicology and Clinical Biology Working Group. [Recommendations for the prescription, implementation and interpretation of medical examinations in biology in the context of severe poisoning]. Ann Biol Clin (Paris). 2012 Jul-Aug;70(4):431-50. doi: 10.1684/abc.2012.0726. French.

    PubMed 22796615
  • Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia. 2008;49 Suppl 1:8-12. doi: 10.1111/j.1528-1167.2008.01443.x.

    PubMed 18184148
  • Chelse AB, Kelley K, Hageman JR, Koh S. Initial evaluation and management of a first seizure in children. Pediatr Ann. 2013 Dec;42(12):244-8. doi: 10.3928/00904481-20131122-08.

    PubMed 24295157
  • Finkelstein Y, Hutson JR, Freedman SB, Wax P, Brent J; Toxicology Investigators Consortium (ToxIC) Case Registry. Drug-induced seizures in children and adolescents presenting for emergency care: current and emerging trends. Clin Toxicol (Phila). 2013 Sep-Oct;51(8):761-6. doi: 10.3109/15563650.2013.829233. Epub 2013 Aug 19.

    PubMed 23957582
  • Thundiyil JG, Kearney TE, Olson KR. Evolving epidemiology of drug-induced seizures reported to a Poison Control Center System. J Med Toxicol. 2007 Mar;3(1):15-9. doi: 10.1007/BF03161033.

    PubMed 18072153
  • Reichert C, Reichert P, Monnet-Tschudi F, Kupferschmidt H, Ceschi A, Rauber-Luthy C. Seizures after single-agent overdose with pharmaceutical drugs: analysis of cases reported to a poison center. Clin Toxicol (Phila). 2014 Jul;52(6):629-34. doi: 10.3109/15563650.2014.918627. Epub 2014 May 20.

    PubMed 24844578
  • Thundiyil JG, Rowley F, Papa L, Olson KR, Kearney TE. Risk factors for complications of drug-induced seizures. J Med Toxicol. 2011 Mar;7(1):16-23. doi: 10.1007/s13181-010-0096-4.

    PubMed 20661684
  • Citak A, Soysal DD, Ucsel R, Karabocuoglu M, Uzel N. Seizures associated with poisoning in children: tricyclic antidepressant intoxication. Pediatr Int. 2006 Dec;48(6):582-5. doi: 10.1111/j.1442-200X.2006.02276.x.

    PubMed 17168978
  • Sharma AN, Hoffman RJ. Toxin-related seizures. Emerg Med Clin North Am. 2011 Feb;29(1):125-39. doi: 10.1016/j.emc.2010.08.011.

    PubMed 21109109
  • Chen HY, Albertson TE, Olson KR. Treatment of drug-induced seizures. Br J Clin Pharmacol. 2016 Mar;81(3):412-9. doi: 10.1111/bcp.12720. Epub 2015 Sep 17.

    PubMed 26174744
  • Cerminara C, El-Malhany N, Roberto D, Lo Castro A, Curatolo P. Seizures induced by desloratadine, a second-generation antihistamine: clinical observations. Neuropediatrics. 2013 Aug;44(4):222-4. doi: 10.1055/s-0033-1333871. Epub 2013 Mar 1.

    PubMed 23456992

Questions about this trial

What is this clinical trial studying?

A study testing Collection of blood and urine samples and Clinical examination in people with Afebrile Seizure (Finding), run by University Hospital, Toulouse at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 28 Oct 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Detection of one or several toxic molecules. (time frame: Day 1). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03310697, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Oct 2021.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in