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Down SyndromePhase 3LESS-ADNCT07234695

LEvetiracetam to Prevent Seizures in Symptomatic Alzheimer's Disease in Adults With Down Syndrome

A Phase 3 study testing Levetiracetam 500mg in people with Down Syndrome and Down Syndrome (DS), run by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau at 5 sites in Spain.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The purpose of this study is to evaluate whether levetiracetam can prevent epileptic seizures in patients with Alzheimer's disease associated with Down syndrome. It will also analyze whether it can delay the neurodegeneration associated with this disease. Read more about this study

Who is it for?
Ages 40 years and older
What is being tested?
Levetiracetam 500mg
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
120 participants
Where
5 sitesSpain
Study dates
22 Dec 2025to Jul 2028
Phase
Phase 3
Are there results?
Not yet: the study is under way

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 40 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Diagnosed with Down Syndrome (DS), either with a karyotype or a compatible typical phenotype.
  • Age over 40 years at time of screening.
  • Symptomatic Alzheimer's Disease (AD) dementia, based on change in functionality and neuropsychological tests' results. Different cut-off points will be established to diagnose dementia depending on the level of intellectual disability of the individual, according to previous experience (Benejam et al; 2020): in adults with mild intellectual disability, a CAMCOG-DS score of 80 and an mCRT score of 29 will be chosen, whereas values of 56 and 28, respectively, will be used in subjects with moderate intellectual disability. Doubtful cases (e.g., with compromised functionality, but without alteration in the neuropsychological assessment) or those unable to complete the evaluation will be categorized by consensus among expert clinicians, using all available clinical information.
  • Willing and able caregiver who has daily contact with the study subject.
  • Subjects and caregivers must be able to comply with the prescribed regimen of study treatment throughout the course of the study and meet a minimum required time commitment of biannual in-person visits.
  • Any concurrent treatment for AD approved by the European Medicines Agency (EMA) must be stable for at least 30 days prior to screening and at least 60 days prior to study day 1. Other medications (except for those listed under exclusion criteria) are allowed as long as the dose is stable for 30 days prior to screening.
  • Subjects and/or their caregivers must be able to provide their consent before participating in any study-related procedures.

Who cannot join

  • Cognitive changes attributable to causes other than AD (for example, but not limited to, uncorrected visual or hearing deficit, severe, untreated sleep apnea or uncontrolled thyroid disorders).
  • Previous history of adult-onset epileptic seizures (over 18 years old).
  • Treatment with any kind of antiepileptic drugs, benzodiazepines, narcotics.
  • Significant comorbidities or analytical abnormalities, such as:
  • Any unstable and/or clinically significant medical condition likely to hamper the evaluation of safety and/or efficacy of the study (eg, moderate and/or severe untreated obstructive sleep apnea, clinically significant reduction in serum B12 or folate levels, clinically significant abnormalities of thyroid function, stroke, or other cerebrovascular conditions), as per investigator's judgement.
  • Severe renal dysfunction (creatinine clearance < 30 mL/min), which would affect serum levetiracetam levels, or any other medical condition which is determined by the investigators to potentially create an undue risk for an adverse effect.
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  • Concomitant or past history psychiatric or neurologic disorder other than those considered to be related to AD (eg, head injury with loss of consciousness, symptomatic stroke, Parkinson's disease, severe carotid occlusive disease, transient ischemic attacks [TIAs]).
  • Significant risk of suicide, defined using the C-SSRS as the subject answering "yes" to suicidal ideation questions 4 or 5 or answering "yes" to suicidal behavior within the past 12 months.
  • Deviations from normal values for hematologic parameters, liver function tests, and other biochemical measures, judged to be clinically significant by the investigator.
  • Participation in another clinical trial within 3 months of screening.
  • Hypersensitivity to the active ingredient, other pyrrolidone derivatives, or any of the excipients
  • Pregnant and breastfeeding patients

Trial locations and contacts

5 sites in 1 country. Contact the study team or a site near you to ask about taking part.

María Carmona Iragui, Doctor contact

+34 93 556 59 56

mcarmonai@santpau.cat

Diego Real de Asúa Cruzat, Doctor contact

diego.realdeasua@salud.madrid.org

5 sites in 1 country

Spain5 sites, 5 recruiting
  • Hospital de la Santa Creu i Sant Pau

    Barcelona, Catalonia, 08041

    Maria Carmona Iragui, Doctor, +34 935565986, mcarmonai@santpau.cat

    Recruiting
  • Fundación CITA Alzheimer

    Donostia / San Sebastian, Basque Country, 20009

    Miren Altuna Azkargorta, Doctor, +34 943 02 17 92, maltuna@cita-alzheimer.org

    Not yet recruiting
  • Hospital Virgen de las Nieves

    Granada, Andalusia, 18014

    Joaquín Escobar Sevilla, Doctor, +34 958 02 00 00, escobarsevillaj@gmail.com

    Not yet recruiting
  • Hospital La Princesa

    Madrid, 28006

    Diego Real de Asúa Cruzat, Doctor, +34 915 20 22 00, diego.realdeasua@salud.madrid.org

    Not yet recruiting
  • Hospital Universitario Marqués de Valdecilla

    Santander, Cantabria, 39008

    Eloy Rodríguez Rodríguez, Doctor, +34 942 20 25 20, eloymrod@gmail.com

    Not yet recruiting

Other trials in Spain

About this study

Official title: A Phase III, Randomized, Double-blinded Study of the Efficacy and Safety of LEvetiracetam to Prevent Seizures in Symptomatic Alzheimer's Disease in Adults With Down Syndrome (the LESS-AD Trial).

The purpose of this study is to evaluate whether levetiracetam can prevent epileptic seizures in patients with Alzheimer's disease associated with Down syndrome. It will also analyze whether it can delay the neurodegeneration associated with this disease.

Patients will be randomly assigned to one of two groups: one group will receive the active drug (levetiracetam), and the other will receive a placebo.

Both groups will receive the treatment for 96 weeks. Each patient will participate for a total of 2 years and 5 months.

Read the detailed description

This study is a clinical trial that will examine the efficacy and safety of a medication called levetiracetam in people with Down syndrome and Alzheimer's disease.

Adults with Down syndrome have a high risk of developing Alzheimer's disease. Epilepsy frequently coexists in these patients, and is associated with a worse clinical outcome. The early dysfunction of inhibitory interneuronal circuits, found in epilepsy, contributes to cognitive decline in Alzheimer's disease patients. Modifying this abnormal activity with levetiracetam could have potential benefits in the treatment of Alzheimer's disease, beyond its benefits on epileptic seizures' control and interictal epileptic activity recorded on EEG. Levetiracetam is a widely used drug with a proven safety profile, with more than 20 years of commercialization. This trial will evaluate the preventive benefit on the development of epileptic seizures in Alzheimer's disease associated with Down syndrome and, secondarily, its effect on cognitive decline and Alzheimer's disease markers. If the described benefits of levetiracetam use are independent of its antiepileptic effect, it could be a drug with a potential disease-modifying effect in Alzheimer's disease.

Primary objective:

To evaluate the efficacy of levetiracetam as a preventive measure for bilateral tonic-clonic seizures at 96 weeks in adults with Alzheimer's disease associated with Down syndrome.

Secondary objectives:

  1. To quantify the time to the first bilateral tonic-clonic seizure between groups (levetiracetam vs. placebo).
  2. To evaluate the incidence of mortality between groups (levetiracetam vs. placebo).
  3. To study changes in biomarkers related to Alzheimer's disease:
  4. Functional changes (CAMDEX-DS)
  5. Cognitive changes (CAMCOG, mCRT)
  6. Plasma biomarkers (217-pTau, NfL)
  7. Brain structure (cortical thickness, hippocampal volume, gray matter volume)
  8. Epileptiform activity (EEG)
  9. Safety: Incidence of adverse events and serious adverse events in the LEV vs. placebo groups.

A total of 120 participants will be included (60 per group).

The dose of levetiracetam to be used in this clinical trial is 1000 mg/day (two doses of 500mg each 12 hours) orally. During the first 4 weeks of the treatment period, LEV, treatment will be administered 500mg/d (250mg/12h) to facilitate the compliance. During the last 4 weeks of the treatment period, LEV will be administered 500mg/d (250mg/12h) to enable a gradual withdrawal.

Participants in placebo arm will receive placebo 1 capsule/12h during the 96 weeks of the treatment period.

The patients will have a total of 12 medical visits during their participation in the study. In those visits the following medical procedures will be carried out:

  • Neuropsychological evaluation
  • Blood analysis
  • Magnetic resonance imaging (MRI)
  • Electroencephalogram (EEG)

This study not only aims to improve the health and quality of life of people with Down syndrome but also to advance our general understanding of Alzheimer's disease, which could benefit more patients in the future.

Being tested
Levetiracetam 500mg, Placebo
Keywords
Down syndrome, epilepsy, Alzheimer, dementia, levetiracetam, prevention, placebo-controlled, epileptic seizures, Alzheimer&#39;s disease markers, phase III, randomized, double-blind, bilateral tonic-clonic seizure, 217-pTau, NfL
Medical subject headings
Down Syndrome, Alzheimer Disease, Epilepsy, Seizures, Dementia, Epilepsy, Tonic-Clonic

What participants receive

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

  • Levetiracetam 500mgDrug

    Use of Levetiracetam to prevent Seizures in Symptomatic Alzheimer's Disease in adults with Down syndrome (the LESS-AD trial)

  • PlaceboDrug

    Comparator

Study groups in NCT07234695
Study groupRoleWhat they receive
Levetiracetam 500 mg/12hExperimentalTablets for twice daily administration for 96 weeks. During the first 4 weeks of the treatment period, LEV, treatment will be administered 500mg/d (250mg/12h) to facilitate the compliance. During the last 4 weeks of the treatment period, LEV will be administered 500mg/d (250mg/12h) to enable a gradual withdrawal.
Receives: Drug: Levetiracetam 500mg
PlaceboPlacebo comparatorTablets for twice daily administration for 96 weeks.
Receives: Drug: Placebo

What is being measured

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

  1. Efficacy of Levetiracetam as a preventive treatment for epileptic seizures in adults with Alzheimer's disease associated with Down syndrome.

    Number (percentage) of subjects who do not develop a bilateral tonic-clonic epileptic seizure during the study treatment phase (96 weeks).

    Measured: From enrollment to the end of treatment at 96 weeks

Secondary outcomes (24)
  1. Time to first bilateral tonic-clonic epileptic seizure

    Baseline (randomization) to first adjudicated epileptic seizure or censoring, up to 96 weeks.

    Measured: days

  2. All-cause mortality

    • All-cause mortality (number and percentage) - Time Frame: Baseline (randomization) to study completion, up to 96 weeks.
    • Alzheimer-related mortality (number and percentage) - Time Frame: Baseline (randomization) to study completion, up to 96 weeks.

    Measured: percentage

  3. Time to death

    Baseline (randomization) to death or censoring, up to 96 weeks.

    Measured: days

  4. Cognition

    CAMCOG-DS (total score): change from baseline and week 96. Change from baseline visit in the CAMCOG-DS total score. Missing visits will be handled per the statistical analysis plan.

    Measured: CAMCOG-DS: change from baseline and week 96.

  5. Plasma biomarkers -217p-tau

    Plasma pTau-217-change (pg/mL) from baseline and week 96. Change from baseline in plasma pTau-217 concentration, quantified using the same laboratory and assay throughout the study.

    Measured: Change from baseline and week 96

  6. Plasma biomarkers- NfL

    Plasma Neurofilament light (NfL) (pg/mL) - Change from Baseline. Change from Baseline in plasma NfL concentration.

    Measured: At week 96

  7. Neuroimaging GMV

    Subcortical gray matter volume - change from Baseline (by region). Change from Baseline in volume (mm³) for 12 subcortical gray matter regions (left/right: amygdala, caudate, nucleus accumbens, pallidum, putamen, thalamus). Each region will be reported separately.

    Measured: At week 96

  8. Neuroimaging- HV

    Hippocampal volume (mm3)- Change from Baseline (left and right). Change from Baseline in hippocampal volume for the left and right hemispheres. Each hemisphere will be reported separately.

    Measured: Change at week 96

  9. Neuroimaging- LVV

    Lateral ventricle volume (mm3) - Change from Baseline (left and right). Change from Baseline in lateral ventricle volume for the left and right hemispheres. Each hemisphere will be reported separately.

    Measured: Week 96

  10. Neuroimaging CTh

    Cortical thickness (mm) - Change from Baseline (by region). Change from Baseline in cortical thickness (mm) for 34 left-hemispheric and 34 right-hemispheric cortical regions. Each region will be reported separately.

    Measured: Week 96

  11. Electroencephalography (EEG)

    Presence of epileptiform/irritative graphoelements. Proportion of participants showing irritative graphoelements (spike-wave, polyspike-wave, sharp waves, focal or generalized slowing) per standardized EEG reading.

    Measured: At week 96.

  12. EEG- band power

    EEG band power (µV²/Hz) - Change from Baseline. Change from Baseline in mean band power (δ, θ, α, β, γ) computed with a prespecified processing pipeline.

    Measured: At week 96

  13. EEG sync

    EEG synchronization/coherence (unitless index (0-1)) - Change from Baseline (by band). Change from Baseline in synchronization/coherence indices by frequency band (dimensionless 0-1) across predefined electrode pairs.

    Measured: At week 96

  14. Safety of Levetiracetam

    The primary endpoints are number, type, frequency, and intensity of AEs evaluated until the end of treatment and assessment of tolerability during the medical visit, physical and neurological examination, vital signs, brain MRI assessment, suicidality (as measured with the C-SSRS), routine hematology and biochemistry evaluation in blood.

    Measured: From enrollment to the end of treatment at 96 weeks

  15. Incidence of adverse events (AEs)

    Proportion (%) of participants:

    • with ≥1 treatment-emergent adverse events (TEAEs)
    • with TEAEs considered related to the treatment by the investigator
    • with ≥1 serious adverse events (SAEs) after first dose of treatment
    • who discontinue the study due to AEs

    Measured: At week 96

  16. AEs- TEAE rate

    TEAE rate- Rate of TEAEs per participant-year of exposure.

    Measured: Up to week 36

  17. Maximum AE severity

    Proportion of participants with at least one TEAE of maximum severity mild, moderate, or severe (% reported by category).

    Measured: At week 96

  18. AEs- Dose interruptions

    Dose interruptions due to AEs. Proportion of participants with ≥1 levetiracetam dose interruption or reduction attributable to AEs.

    Measured: At week 96.

  19. Vital signs- BP

    Systolic and diastolic blood pressure (mmHg)- Change from Baseline in systolic and diastolic blood pressure.

    Measured: At week 96

  20. Vital signs- HR

    Heart rate. Change from Baseline in resting heart rate (bpm).

    Measured: At week 96

  21. Physical examination

    Clinically significant abnormalities on physical/neurological exam. Proportion of participants with new or worsening clinically significant findings on physical or neurological examination.

    Measured: Week 96

  22. Brain MRI safety

    Clinically significant new MRI findings. Proportion of participants with new clinically significant MRI findings (e.g., edema, hemorrhage) vs Baseline.

    Measured: At week 96

  23. Suicidality (C-SSRS)

    Suicidal ideation or behavior (C-SSRS). Proportion of participants with any positive suicidal ideation or behavior signal on the C-SSRS.

    Measured: Week 96

  24. Laboratory safety

    Treatment-emergent hematology and biochemistry abnormalities:

    • Proportion of participants with ≥1 treatment-emergent hematology abnormality meeting predefined thresholds (e.g., CTCAE grade ≥2).
    • Proportion of participants with ≥1 treatment-emergent biochemistry abnormality meeting predefined thresholds (e.g., CTCAE grade ≥2).

    Measured: At week 96

Timeline

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

  1. First posted18 Nov 2025
  2. Study start22 Dec 2025 (estimated)
  3. Primary completionDec 2027 (estimated)
  4. Study completionJul 2028 (estimated)

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 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a phase III, national, multicenter, randomized, double-blind, parallel-group, placebo-controlled clinical trial to evaluate the safety and efficacy of levetiracetam as a preventive treatment for epileptic seizures in adults with Alzheimer's disease associated with Down syndrome.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07234695
Sponsor's protocol ID
IIBSP-LEV-2024-86
Other IDs
2024-516148-24-00
Acronym
LESS-AD
Status last verified
Dec 2025
First submitted
2 Oct 2025
Last updated
12 Jan 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Levetiracetam 500mg in people with Down Syndrome and Down Syndrome (DS), run by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau at 5 sites in Spain.

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 7 inclusion and 12 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: looking for participants now, as of the sponsor's last update on 12 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in Spain. 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact María Carmona Iragui, Doctor (+34 93 556 59 56, mcarmonai@santpau.cat), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Efficacy of Levetiracetam as a preventive treatment for epileptic seizures in adults with Alzheimer's disease associated with Down syndrome. (time frame: From enrollment to the end of treatment at 96 weeks). 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 12 Jan 2026.

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