Pilot Study of the Effects of the Desipramine on the Neurovegetative Parameters of the Child With Rett Syndrome

Study Overview
=================
Brief Summary
-----------------
Rett syndrome is a neurodevelopmental disorder characterized by cognitive impairment, communication dysfunction, stereotypic movement disorder, and growth failure. Rett syndrome is caused by mutations in the Methyl CpG-Binding Protein-2 (MECP2) gene and has no treatment. A mouse experimental model of Rett syndrome created by genetic invalidation of the MECP2 gene is available. It had been then observed that adult MECP2-deficient mice show respiratory alterations and found that endogenous noradrenaline helps to maintain a normal respiratory rhythm. Desipramine, a selective inhibitor of norepinephrine reuptake, seems to be efficient to reduce the respiratory alteration occuring in MECP2-deficient mice (Insem patent 2005, Villard and Roux 2006). The aim of the study is to evaluate these obtained results in MECP2-deficient mice on patients with Rett syndrome.

Detailed Description
-----------------
Rett syndrome is a neurodevelopmental disorder characterized by cognitive impairment, communication dysfunction, stereotypic movement disorder, and growth failure. The diagnosis of Rett syndrome is based on consensus clinical criteria. Rett syndrome is caused by mutations in the Methyl CpG-Binding Protein-2 (MECP2) gene and has no treatment. Only a few improved cases have been reported concerning buspirone (Andaku, 2005, 1 patient), topiramate (Goyal, 2004, 8 patients), diazepam (Kurihara, 2001, 1 patient) and carnitin (Plochl, 2004, 1 patient). Only one randomized study versus placebo has been published about a treatment by naltrexone including 25 patients. A light improvement of respiratory parameters was then observed with a deterioration of the cognitive function (Percy, 2004). A mouse experimental model of Rett syndrome created by genetic invalidation of the MECP2 gene is available. It had been then observed that adult MECP2-deficient mice show respiratory alterations and found that endogenous noradrenaline helps to maintain a normal respiratory rhythm. Desipramine, a selective inhibitor of norepinephrine reuptake, seems to be efficient to reduce the respiratory alteration occuring in MECP2-deficient mice (Insem patent 2005, Villard and Roux 2006). The aim of the study is to evaluate these obtained results in MECP2-deficient mice on patients with Rett syndrome.

Official Title
-----------------
Pilot Study of the Effects of the Desipramine on the Neurovegetative Parameters of the Child With Rett Syndrome

Conditions
-----------------
Rett Syndrome

Intervention / Treatment
-----------------
* Drug: Administration of a high dose of desipramine
* Drug: Administration of a low dose of desipramine
* Drug: Administration of a placebo


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Rett syndrome; Girls weighing less than 60 kg; Respiratory alteration; Diagnosis of Rett syndrome confirmed by MECP2 genotyping (Xq28). Exclusion Criteria: Boys; Pregnancy and breath feeding; Case history of status epilepticus; Patient treated by IMAO or sultopride; Hepatic or renal failure.

Ages Eligible for Study
-----------------
Minimum Age: 4 Years
Maximum Age: 18 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Desipramine high dose<br>12 patients with Rett syndrome receiving a daily dose of desipramine correlated with the weight : From 15 to 25 kg : 50 mg ; From 26 to 35 kg : 75 mg ; From 36 to 45 kg : 100 mg ; > 46 kg : 150 mg. | Drug: Administration of a high dose of desipramine<br>* Administration of a daily dose of desipramine correlated with the patient's weight : From 15 to 25 kg : 50 mg ; From 26 to 35 kg : 75 mg ; From 36 to 45 kg : 100 mg ; > 46 kg : 150 mg.<br>|
| Experimental: Desipramine low dose<br>12 patients with Rett syndrome receiving a daily dose of desipramine correlated with the weight : From 15 to 25 kg : 25 mg ; From 26 to 35 kg : 50 mg ; From 36 to 45 kg : 75 mg ; > 46 kg : 100 mg. | Drug: Administration of a low dose of desipramine<br>* Administration of a daily dose of desipramine correlated with the patient's weight : From 15 to 25 kg : 25 mg ; From 26 to 35 kg : 50 mg ; From 36 to 45 kg : 75 mg ; > 46 kg : 100 mg.<br>|
| Placebo Comparator: Placebo<br>12 patients with Rett syndrome receiving a daily dose of placebo. | Drug: Administration of a placebo<br>* Administration of a daily dose of placebo<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To study the efficacy of the desipramine on the respiratory disturbations |  | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To study the safety of the desipramine in the studied population |  | 2 years | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Rett syndrome