Tolerability and Efficacy of Depakote-extended Release in the Elderly

Not Applicable

Completed

Conditions: Elderly
Seizures
Epilepsy

Registration Number: NCT00318929

Lead Sponsor: Virginia Commonwealth University

Brief Summary: There is a bimodal distribution to the new onset seizures with one peak occurring in the very young and the second peak occurring in persons over age 65 years. The presentation of seizures in the elderly may vary from that of younger patients and the diagnosis may be confused with other conditions such as transient ischemic attacks. However, the consequences of epilepsy in the elderly can be severe leading to impaired cognition, increased falls, and a decreased quality of life. The treatment of epilepsy may be complicated by pharmacokinetic and pharmacodynamic changes occurring in the elderly.

Detailed Description: There is a bimodal distribution to the new onset seizures with one peak occurring in the very young and the second peak occurring in persons over age 65 years. The presentation of seizures in the elderly may vary from that of younger patients and the diagnosis may be confused with other conditions such as transient ischemic attacks. However, the consequences of epilepsy in the elderly can be severe leading to impaired cognition, increased falls, and a decreased quality of life. The treatment of epilepsy may be complicated by pharmacokinetic and pharmacodynamic changes occurring in the elderly.

Three Veterans Cooperative trials evaluating antiepileptic drug (AED) therapy in the elderly demonstrated that the ability to tolerate the AED is a more determining factor for long term success than the ability to suppress seizure activity. In general, elderly patients appear more intolerable to medications. This may stem from co-morbid conditions, concurrent medications, pharmacokinetic changes, and/or pharmacodynamic changes. Therefore, it is important to study the efficacy and tolerability of AEDs in the elderly.

Valproic acid has been available for the treatment of partial and generalized seizures since 1978. Sodium divalproex is metabolized in the gut to valproic acid. Depakote and Depakote-ER (extended release)are among the dosage forms of sodium divalproex. Depakote is an enteric coated tablet that is designed to dissolve in the more alkaline milieu of the small intestine rather than the more acidic milieu of the stomach. This helps the drug to bypass the stomach and reduces gastrointestinal distress. Once the enteric coating dissolves, the sodium divalproex is metabolized to valproic acid and rapidly absorbed. Depakote is administered twice a day. Depakote-ER is a controlled release drug delivery system designed to release drug over a 22 hour period which allows for once a day dosing. The efficacy and tolerability of Depakote-ER has not been described in elderly patients with epilepsy.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 14

Inclusion Criteria

Is > 60 years of age (male or female)
Has a confirmed diagnosis of epilepsy with partial seizures
Has one of the following
1. newly diagnosed partial seizures
2. has inadequately controlled partial seizures, i.e. continues to have seizure activity while on his/her medication regimen
3. is taking Depakote twice a day for partial seizures but is having side effects or problems with adherence and may benefit from once a day dosing
Is able and willing to maintain an accurate, complete, written daily seizure diary
Is able and willing to complete the QOLIE, the Beck Depression Inventory, and the SSQ
Is able to given written informed consent
Is compliant with clinic visits
Is able to swallow Depakote-ER

Exclusion Criteria

Has had status epilepticus in the 24 weeks prior to the Baseline Phase of the Study
Is taking three or more AEDs chronically
Is currently abusing alcohol and/or any other substance
Has taken an investigational drug within the previous 30 days or plans to take an investigational drug anytime during the study
Is receiving any medication that could influence seizure control
Is currently following the ketogenic diet
Is planning surgery or the insertion of the vagal nerve stimulator for seizure control during the course of the study.
Is suffering from acute or progressive neurologic disease, severe psychiatric disease, or severe mental abnormality that are likely to interfere with the objectives of the study
Has any clinically significant cardiac, renal, hepatic condition, or a condition that affects the absorption, distribution, metabolism or excretion of drugs.
Baseline elevations of LFTs more than 3 times normal, clinically elevated amylase, and clinically significant thrombocytopenia

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Primary Outcome Measures

Name	Time	Method
Effectiveness of Medication as Measured by Participation Through the End of the Trial.	24 weeks	Number of participants completing the trial

Secondary Outcome Measures

Name	Time	Method
Patient's Compliance With Once a Day Dosing.	24 weeks	Subjects pill count for once a day dosing and compliance with medication as a percent of total doses prescribed.
Number of Seizures Per Month	24 weeks	Count of seizures per month determined by seizures recorded in diaries.
Change From Baseline as Measured by the Seizure Severity Questionnaire (SSQ)	24 weeks	Seizure Severity Questionnaire summary score, on a scale of 1 to 7 with one being the least severe and 7 being the most severe, components of seizures include; warning, activity and recovery