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NINDS Workshop: Challenges in Epilepsy Clinical Trials

Fairmont Turnberry Isle Resort
Aventura, Florida
April 30, 2011


Salon VIII

Purpose: Identify the key problems facing epilepsy clinical trials and propose new approaches (why do trials fail and what can we do to fix them?)

Methodology: Working groups formed in advance of the meeting will prepare a proposal to be presented to the larger group for discussion.

8:00 - 8:15 Welcome (Fureman and French)

Morning sessions: Issues with Trial Methodology

8:15-8:45 Overview: Current status (French)

  • Inconsistent/incorrect phenotyping leads to variability (global site problem)
  • Inclusion/exclusion criteria (global site problem)
  • Reluctance to enroll patients when other approved meds available to try
  • Retention problem
  • Placebo response
  • Pediatrics
  • Acute vs chronic treatment


Session I: Inclusion/exclusion criteria

Working Group: Bergey, Perucca, Hesdorffer, (MaryAnn) Brodie, Versavel, Kossoff, Hirtz

Are currently used inclusion/exclusion criteria appropriate and effective? Will harmonization make trial results more comparable?

8:45-9:00: Presentation   

9:00-10:00: Open Discussion

Deliverable: Inclusion/Exclusion criteria


10:00-10:15: Coffee Break


Session II: Epilepsy/Seizure confirmation

What should be done to ensure appropriate adult and pediatric patients are enrolled? How should investigators be trained?

Working group: Friedman, Schachter, Glauser, Kwan, Kramer, LaFrance

10:15-10:30 Presentation

10:30-11:30: Open Discussion

Deliverable: Plan for screening of potential patients to ensure proper patients are enrolled


Session III: Seizure Diaries

Working Group: Fisher, Herman, Vogelsong, Vannest

What are the problems with existing diaries? What are new/alternative options? How should new methods be validated?  How should investigators be trained on seizure classification and diary evaluation?

11:30-11:45: Presentation

11:45-12:30: Open Discussion

Deliverables: Recommendation on seizure diaries, Plan for investigator training.


12:30-1:30: Working Lunch (Salon II)


Afternoon sessions: Issues with Trial Design

1:00-1:30: Overview of current status (Baulac)


  • Clinical trial outcome measures
  • Monotherapy trials
  • Adaptive designs
  • Non-inferiority trials
  • Combination therapy trials
  • Targeted population trials
  • Modeling from prior trials


Session IV: Trial designs: Monotherapy

Working group:

Messenheimer, (Martin) Brodie, Baulac, Blum, Mintzer, Dlugos, Gilbert, Stables

Are current designs in Europe and the US feasible, interpretable, appropriate, acceptable? Is there an alternative design that would be acceptable to both EMA and FDA?

1:30-1:45: Presentation

1:45-2:30: Open Discussion

Deliverable: Considerations for monotherapy design for US and Europe


Session V: Trial designs: Add-on trial considerations

Working group: Ryvlin, French, Bagiella, Emir, Arzimanoglou, Elterman

Are current designs supportable, ethical? What are the alternatives? Should we consider time to event, adaptive designs, other solutions?

2:30-2:45: Presentation

2:45-3:30: Open Discussion

Deliverables: Novel Trial Design for adjunctive epilepsy trials


3:30: Wrap-up (Fureman and French)


4:15: Meeting concludes

Last Modified February 6, 2013