Efficacy of Levetiracetam in Oromandibular and Cranial Dystonia
Condition: Oromandibular Dystonia; Cranial Dystonia
MeSH terms: Dystonia; Dystonic Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      Background:

      - People with dystonia cannot control their muscle contractions. This disorder can affect
      different body areas. When it affects the face, tongue, and jaw, it is called oromandibular
      dystonia (OMD) or cranial dystonia (CD). Researchers want to find out if a drug that treats
      seizures may help people with this kind of dystonia.

      Objective:

      - To see if levetiracetam can improve symptoms of jaw or face dystonia.

      Eligibility:

      - Adults ages 18 to 80 years with OMD or CD.

      Design:

        -  Participants will be screened with a medical history and physical exam. Researchers will
           test how severe their dystonia is.

        -  Participants will have blood drawn through a needle in the arm.

        -  Participants will be assigned to take either levetiracetam or placebo.

        -  Phase 1:

        -  Participants will start with one 500-mg tablet twice daily. The dose will be increased
           by 500 mg every 3 days. The maximum dose will be 4000 mg a day over 3 weeks.
           Participants who cannot tolerate that will take the highest dose they can.

        -  Participants will return for study visits at weeks 3 and 6. They will be asked about
           their health, side effects, and symptoms of depression. They will have a neurological
           examination and test of their dystonia.

        -  After the week 6 visit, participants will taper and stop the study drug over about 1
           week.

        -  Phase 2 begins one week later. Participants will repeat phase 1, but with the other
           drug.

        -  After phase 2, participants will return to their usual clinics. They will be told how to
           stop taking the drug. They will have a follow-up phone call 2 weeks later.
    

Detailed description: 
      Objectives:

      --To determine the efficacy of levetiracetam (LVT) for reducing the symptoms of subjects with
      oromandibular dystonia (OMD) or cranial dystonia (CD) as assessed by dystonia rating scales
      and to report all adverse events in this study.

      Sample Size and Population:

      --We plan to recruit 10 subjects with either primary OMD or CD from the Movement Disorders
      and Botulinum Toxin (BoNT) Clinics of HMCS.

      Design:

      --This is a randomized, double-blind placebo controlled cross-over study. All subjects will
      receive a baseline evaluation and have their dystonia assessed by the eyes, mouth, speech and
      swallowing subscores of the Burke-Fahn-Marsden (BFM) dystonia scale, and the eyes and upper
      and lower face, jaw, and tongue subscores of the Global Dystonia Severity (GDS) rating scale.
      They will then be randomized into two groups. Either LVT or placebo with a titration schedule
      up to a total daily dose of 4000 mg will be prescribed for six weeks. After week 6, all
      subjects will undergo tapering and a wash-out period (one week for tapering off and one week
      for the washout). The two groups will then be switched to the opposite intervention (LVT or
      placebo), following the same titration and tapering pattern. We will evaluate both groups at
      weeks 3, 6, 11 and 14 using the same scales. This study requires six outpatient visits to the
      NIH CC; the total duration of this study will be 15 weeks.

      Outcome measurement:

      Primary outcome: The percent change of sum of the eyes, mouth, speech and swallowing
      subscores of BFM dystonia scale at weeks 6 and 14 comparing to the baseline.

      Secondary outcome: The percent change of the sum of the eyes, mouth, speech and swallowing
      subscores of BFM dystonia scale at weeks 3 and 11 and sum of eyes and upper face, lower face
      and jaw and tongue subscores of the GDS rating scale at weeks 3, 6, 11 and 14 comparing to
      baseline and all adverse events.
    

Intervention name(s): Levetiracetam
Intervention type(s): Drug
Intervention description(s): Anticonvulsant
Intervention MeSH terms: Levetiracetam
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Other
Keywords: Levetiracetam; Cranial Dystonia; Oromandibular Dystonia