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AzTrials

EpilepsyeCORTANCT05551403

Cortical Excitability and Treatment Response in People with Epilepsy

A study testing Eyes-closed rest-EEG registration, Transcranial Magnetic Stimulation during EEG and EMG registrations and Photic stimulation during eyes-closes EEG registration in people with Epilepsy, run by Stichting Epilepsie Instellingen Nederland at 2 sites in Netherlands.

Completed

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

Official record
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Trial summary

Epilepsy is a medical condition marked by the occurrence of unpredictable, recurrent seizures. One-third of people with epilepsy continue to experience seizures, despite having attempted multiple forms of anti-seizure medication (ASM). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Epilepsy
What is being tested?
Eyes-closed rest-EEG registration, Transcranial Magnetic Stimulation during EEG and EMG registrations and Photic stimulation during eyes-closes EEG registration
Could I receive a placebo?
No, everyone receives an active treatment
How many people
28 participants
Where
2 sitesNetherlands
Study dates
16 Mar 2022to 14 Feb 2025
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • In agreement with their own neurologist to initiate adjuvant treatment with cenobamate
  • Diagnosed with refractory focal epilepsy, which means two ASMs failed to cause seizure freedom.
  • Age of 18 years or older
  • Having kept a seizure diary for the past 12 weeks
  • At least one seizure in the past 12 weeks.

Who cannot join

  • Photosensitive epilepsy
  • Any device or structure in the skull or in close proximity of the head area containing metal, including cochlear implants, implanted neurostimulators, cardiac pacemakers and intracardiac lines.
  • Persistent skull opening following trauma or surgery
  • Evidence (clinical or radiological) of major structural abnormality of the motor cortex or pyramidal tracts
  • Any major psychiatric condition such as a psychotic disorder
  • Pregnancy
  • Learning disabilities preventing the comprehension of oral and/or written instructions

Trial locations and contacts

2 sites in 1 country.

Netherlands2 sites
  • Stichting Epilepsie Instellingen Nederland (SEIN)

    Heemstede, North Holland, 2103 SW

  • Erasmus Medical Center

    Rotterdam, South Holland, 3015 CN

Other trials in Netherlands

About this study

Official title: Electrophysiological Markers of Cortical Excitability to Predict Response to Treatment with Anti-seizure Medication - the ECORTA Study

Epilepsy is a medical condition marked by the occurrence of unpredictable, recurrent seizures. One-third of people with epilepsy continue to experience seizures, despite having attempted multiple forms of anti-seizure medication (ASM). Currently, response to ASM is assessed on a trial-and-error basis as their efficacy can only be determined in hindsight. This causes delays in finding the proper treatment per individual. Responsiveness of the outer brain layer to external stimuli, termed cortical excitability (CE), may be used as additional means of treatment evaluation.

In this study, the investigators aim to measure CE before and after starting with ASM, so as to determine whether indicators of CE can be used to predict favorable response to the medication. Participants in this study are adult individuals with uncontrolled seizures that will start with the novel anti-seizure medicine cenobamate. The investigators hypothesize that, after starting with ASM, the CE will decrease in people with epilepsy who show a favorable response to the medication. Conversely, the investigators anticipate that the CE will not decrease in those that do not react to the mediation.

The investigators will address this hypothesis by evaluating both brain activity (electroencephalography, EEG) during rest and during different types of stimulation (magnetic, light flashes). Besides, the investigators will measure the subjective experiences of participants by using questionnaires on the quality of life and feelings of anxiety or depression. These measurements are performed at a baseline instance, just before starting with ASM, and at two instances after start with the ASM. Participants in the study will track the occurrence of seizures - using a diary - from 12 weeks before ASM start up till 12 months after ASM start. The investigators will compare seizure frequency with both changes in brain activity and subjective experiences by the participants.

Conditions
Epilepsy
Being tested
Eyes-closed rest-EEG registration, Transcranial Magnetic Stimulation during EEG and EMG registrations, Photic stimulation during eyes-closes EEG registration
Keywords
Epilepsy, Transcranial Magnetic Stimulation, Evoked Potentials, Visual, Electroencephalography, Anticonvulsants, Seizures
Medical subject headings
Epilepsy, Seizures

What participants receive

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

  • Eyes-closed rest-EEG registrationDevice

    Recording of spontaneous brain activity while eyes are shut for the duration of 7 minutes using a tablet with instructions

  • Transcranial Magnetic Stimulation during EEG and EMG registrationsDevice

    Recording of TMS-evoked EEG and EMG responses according to various stimulation protocols

  • Photic stimulation during eyes-closes EEG registrationDevice

    Recording of visual evoked potentials in the EEG during flash stimulation by light-emitting diode (LED) goggles (while eyes are closed)

Study groups in NCT05551403
Study groupRoleWhat they receive
rest-EEG, TMS-EEG/TMS-electromyography(EMG) and photic stimulationExperimentalNot described
Receives: Device: Eyes-closed rest-EEG registration; Device: Transcranial Magnetic Stimulation during EEG and EMG registrations; Device: Photic stimulation during eyes-closes EEG registration

What is being measured

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

  1. Influence of cenobamate initiation on the resting motor threshold (rMT) when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using the rMT in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  2. Influence of cenobamate initiation on transcranial magnetic stimulation (TMS)-evoked EEG potentials (TEP) when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using TEP amplitudes in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

Secondary outcomes (10)
  1. Influence of cenobamate initiation on phase clustering and the neural network excitability index (NNEI) between visual evoked potential (VEP) trials when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using VEP parameters (i.e. phase clustering and directly-related NNEI) in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  2. Influence of cenobamate initiation on the mean functional connectivity (MFC) and phase-amplitude coupling (PAC) in resting-state (rs-)EEG data when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability using rs-EEG parameters (i.e. MFC and PAC values in the 0-120 Hz EEG frequency range) in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  3. Influence of cenobamate initiation on transcranial magnetic stimulation (TMS)-EMG and EEG, intermittent photic stimulation (IPS)-EEG and resting state (rs-)EEG parameters when comparing long-term responders and non-responders

    TMS-EMG/-EEG parameters, IPS-EEG parameters, and rs-EEG parameters at T0, T1 and T2, incorporated as factors in a single multivariate statistical model alongside a factor for cenobamate response; i.e. responder or non-responder. Classification into the latter is determined by comparing the seizure frequency in the 12 months post-cenobamate initiation to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2).

  4. Correlation between the pre- to post-cenobamate initiation change in the resting motor threshold (rMT) and change in the seizure frequency when comparing short-term responders and non-responders to cenobamate

    Classification of subjects into responders and non-responders to cenobamate is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  5. Influence of cenobamate initiation on transcranial magnetic stimulation-induced EEG oscillations (TIO) when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using TIO in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  6. Influence of cenobamate initiation on phase clustering between TEP trials when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using phase clustering between TEP trials in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  7. Influence of cenobamate initiation on the neural network excitability index (NNEI) between TEP trials when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using the NNEI between TMS-evoked EEG potential trials in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  8. Influence of cenobamate initiation on the short-interval intracortical inhibition (SICI) when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using SICI of motor evoked potential amplitudes in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  9. Influence of cenobamate initiation on the long-interval intracortical inhibition (LICI) when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using LICI of motor evoked potential amplitudes in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

  10. Influence of cenobamate initiation on the cortical silent period (CSP) when comparing short-term responders and non-responders

    Pre- to post-cenobamate initiation change in cortical excitability assessed using the CSP after motor evoked potentials in responders vs. non-responders. Classification into the latter is determined by comparing the seizure frequency in the 3 months post-target dose interval to the seizure frequency in the 3 months baseline interval (responder determined by a significant seizure reduction according to Poisson distribution statistics).

    Measured: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)

Timeline

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

  1. First posted22 Sep 2022
  2. Study start16 Mar 2022
  3. Primary completion29 Feb 2024
  4. Study completion14 Feb 2025

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
Supportive care
Allocation
Not applicable
Intervention model
Sequential
Masking
None (open label)
Enrolment
28 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05551403
Sponsor's protocol ID
NL77887.058.21
Other IDs
P21.092
Acronym
eCORTA
Status last verified
Apr 2024
First submitted
22 Jun 2022
Last updated
20 Feb 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Eyes-closed rest-EEG registration, Transcranial Magnetic Stimulation during EEG and EMG registrations and Photic stimulation during eyes-closes EEG registration in people with Epilepsy, run by Stichting Epilepsie Instellingen Nederland at 2 sites in Netherlands.

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 5 inclusion and 7 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 20 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Netherlands. 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?

Influence of cenobamate initiation on the resting motor threshold (rMT) when comparing short-term responders and non-responders (time frame: At cenobamate initiation (T0), 7-8 weeks after cenobamate initiation (T1), and optionally at the maximum dose reached after individual treatment durations up to 1 year after cenobamate initiation (T2)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 20 Feb 2025.

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