A Phase I trial of Non-invasive Ventilation and seizure prophylaxis with levetiracetam In Children with Cerebral Malaria Trial (NOVICE-M Trial).

Autor:	Maitland K; Department of Infectious Disease and Institute of Global Health and Innovation, Division of Medicine, Imperial College London, London, England, W2 1PG, UK.; KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya., Obonyo N; KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya., Hamaluba M; KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya., Ogoda E; KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya., Mogaka C; KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya., Williams TN; Department of Infectious Disease and Institute of Global Health and Innovation, Division of Medicine, Imperial College London, London, England, W2 1PG, UK.; KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya., Newton C; KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya.; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK., Kariuki SM; KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya.; Department of Public Health, Pwani University, Kilifi, Kilifi County, Kenya., Gibb DM; Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK., Walker AS; Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK., Connon R; Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK., George EC; Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK.
Jazyk:	angličtina
Zdroj:	Wellcome open research [Wellcome Open Res] 2024 May 20; Vol. 9, pp. 281. Date of Electronic Publication: 2024 May 20 (Print Publication: 2024).
DOI:	10.12688/wellcomeopenres.21403.1
Abstrakt:	Background: African children with cerebral malaria and seizures caused Plasmodium falciparum are at greater risk of poor outcomes including death and neurological sequelae. The agonal events are severe hypoventilation and respiratory arrest often triggered by seizures. We hypothesised that prophylactic anti-seizure medication (ASM) could avert 'spikes' of intracranial pressure during or following seizures and that adequate ventilation could be supported by biphasic Cuirass Ventilation (BCV) which requires no intubation. Methods: A Phase I trial conducted in Kilifi, Kenya designed to provide data on safety, feasibility and preliminary data on seizure control using prophylactic ASM (levetiracetam) and BCV as non-invasive ventilatory support in children with cerebral malaria. Children aged 3 months to 12-years hospitalised with P falciparum malaria (positive rapid diagnostic test or a malaria slide), a Blantyre Coma Score ≤2 and a history of acute seizures in this illness are eligible for the trial. In a phased evaluation we will study i) BCV alone for respiratory support (n=10); ii) prophylactic LVT: 40mg/kg loading dose then 30mg/kg every 12 hours given via nasogastric tube for 72 hours (or until fully conscious) plus BCV support (n=10) and; iii) prophylactic LVT: 60mg/kg loading dose then 45mg/kg every 12 hours given via nasogastric tube for 72 hours (or until fully conscious) plus BCV support (n=10). Primary outcome measure: cumulative time with a clinically detected seizures or number of observed seizures over 36 hours. Secondary outcomes will be assessed by feasibility or ability to implement BCV, and recovery from coma within 36 hours. Safety endpoints include: aspiration during admission; death at 28 days and 180 days; and de-novo neurological impairments at 180 days. Conclusions: This is a Phase I trial largely designed to test the feasibility, tolerability and safety of using non-invasive ventilatory support and LVT prophylaxis in cerebral malaria. Registration: ISRCTN76942974 (5.02.2019); PACTR202112749708968 (20.12.2021). Competing Interests: No competing interests were disclosed. (Copyright: © 2024 Maitland K et al.)
Databáze:	MEDLINE
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