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The purpose of this project is to study the efficacy of triheptanoin oil in patients with Alternating Hemiplegia of Childhood (AHC) due to ATP1A3 gene mutation.
The clinical spectrum of Alternating Hemiplegia of Childhood (AHC) is wide and characterized by the association of permanent and paroxysmal (palsy, dystonia, ocular, epileptic, dysautonomic events) neurological events, with onset in childhood. Most of AHC patients carry mutations in the ATP1A3 gene. This gene encodes the Na+/K+ ATPase witch is a transmembrane ion pump generating chemical and electrical gradient of sodium and potassium across the plasma membrane. Those paroxystic events in AHC patients with mutations in the ATP1A3 gene could be associated with a glucidic/energetic metabolism or intracerebral excitability disorder.
Triheptanoin is a triglyceride, whose derivatives pass the blood - brain barrier and enhance the Krebs cycle functions. Triheptanoin could therefore allow energy supply to the brain, which is essential for the functioning of the Na+/ K+ ATPase that consumes a significant amount of energy in the brain.
The investigators goal is to do a pilot study to test the effectiveness on paroxystic manifestations and the safety of triheptanoin in a small group of patients with Alternating Hemiplegia of Childhood secondary to ATP1A3 mutations.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Triheptanoin | Active Comparator | Triheptanoin/ Placebo Randomized to receive active Triheptanoin first for 12 weeks. At cross-over, participants will receive placebo for 12 weeks. Each drug will be dispensed successively. A one-month wash out period is planned for 4 weeks between triheptanoine and placebo phases. |
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| Placebo | Placebo Comparator | Placebo / Triheptanoin Randomized to receive active Placebo first for 12 weeks. At cross-over, participants will receive Triheptanoin for 12 weeks. Each drug will be dispensed successively. A one-month wash out period is planned for 4 weeks between placebo and triheptanoin phases. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Triheptanoin | Drug | Triheptanoin is a triglyceride composed of three heptanoate (C7 fatty acid) esters. Triheptanoin is manufactured by chemical synthesis from glycerol and heptanoic acid. Triheptanoin is a liquid, intended for oral (PO) administration. Participants will be given approximately 1g/kg of Triheptanoin divided at least in three doses (at 8 am, 12 noon, and 8 pm). A one-day titration period will be used, using 0.5 g/kg increments before arriving at the full dose. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of neurologic paroxystic events report in patient diary | visit 1 at day 0, visit 2 at week 12, visit 3 at week 16, visit 4 at week 28 | 7 months |
| Measure | Description | Time Frame |
|---|---|---|
| Composite score allying the number of neurological paroxystic events, their duration and severity. | visit 1 at day 0, visit 2 at week 12, visit 3 at week 16, visit 4 at week 28 | 7 months |
| Clinical Global Impression Scales - Improvement |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Emmanuel Flamand-Roze, MD, PhD | INSERM UMRS 975, 47 bd de l'hôpital - 75651 Paris Cedex 13 | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Groupe hospitalier Pitié Salpêtrière | Paris | 75013 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28969699 | Result | Hainque E, Caillet S, Leroy S, Flamand-Roze C, Adanyeguh I, Charbonnier-Beaupel F, Retail M, Le Toullec B, Atencio M, Rivaud-Pechoux S, Brochard V, Habarou F, Ottolenghi C, Cormier F, Meneret A, Ruiz M, Doulazmi M, Roubergue A, Corvol JC, Vidailhet M, Mochel F, Roze E. A randomized, controlled, double-blind, crossover trial of triheptanoin in alternating hemiplegia of childhood. Orphanet J Rare Dis. 2017 Oct 2;12(1):160. doi: 10.1186/s13023-017-0713-2. |
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| Placebo | Drug | Placebo is a oily liquid, intended for oral (PO) administration. Participants will be given approximately 1g/kg of Placebo divided at least in three doses (at 8 am, 12 noon, and 8 pm). A one-day titration period will be used, using 0.5 g/kg increments before arriving at the full dose. |
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visit 2 at week 12, visit 4 at week 28
| 7 months |
| The Short Form (36) Health Survey | visit 1 at day 0, visit 2 at week 12, visit 3 at week 16, visit 4 at week 28 | 7 months |
| Brain 31phosphorus magnetic resonance spectroscopy | Ratio of Inorganic Phosphate (Pi) over Phosphocreatine during visual stimulation visit 2 at week 12, visit 4 at week 28 | 7 months |
| Clinical Safety as measured by questionnaire | visit 2 at week 12, visit 4 at week 28 | 7 months |
| Biological Safety as measured by acylcarnitine profile, organic acid dosage | visit 2 at week 12, visit 4 at week 28 | 7 months |
| ID | Term |
|---|---|
| C536589 | Alternating hemiplegia of childhood |
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| ID | Term |
|---|---|
| C531010 | triheptanoin |
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