Lithium Treatment for Patients With Spinocerebellar Ataxia Type I - Full Text View

Sponsored by:	National Institute of Neurological Disorders and Stroke (NINDS)
Information provided by:	National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier:	NCT00683943

Purpose

This study will evaluate the side effects and tolerability of the drug lithium in patients with spinocerebellar ataxia type I (SCA1) an inherited disorder caused by loss of nerve cells in parts of the brain. Symptoms include ataxia (difficulty walking) and loss of muscle coordination and strength. Recent studies suggest that lithium may be helpful in treating some SCA1 symptoms.

People between 18 and 65 years of age with SCA1 who have only difficulty walking or who have difficulty walking as well as tremor, hand incoordination or speech problems, may be eligible for this study. Participation requires three hospital admissions at the NIH Clinical Center and one outpatient visit.

Participants undergo the following tests and procedures:

Admission 1 (2-6 weeks)

Medical history, physical examination, blood and urine tests, electrocardiogram.
Evaluation of SCA1 symptoms (balance, walking, dexterity, tremor, memory, mood and concentration).
Monitoring of liquid intake and output (urine) and weight changes.
Lithium treatment - Start treatment and remain in hospital until the blood level of the drug is stabilized; continue treatment at home after hospital discharge.

Admission 2 (2-4 days, 4 weeks after hospital discharge).

Repeat of some or all of the procedures done at the first admission.
Continue lithium in hospital and at home after discharge, with local physician checking laboratory values as needed.

Admission 3 (2-4 days, 8 weeks after Admission 2).

Repeat of some or all of the procedures done at other admissions.
Stop lithium.

Outpatient Visit (4 weeks after Admission 3)

Evaluation of SCA1 symptoms.
Blood and urine tests.

Condition	Intervention	Phase
Spinocerebellar Ataxia Type I	Drug: Lithium Carbonate	Phase I

Genetics Home Reference related topics: familial encephalopathy with neuroserpin inclusion bodies Friedreich ataxia

MedlinePlus related topics: Tremor

Drug Information available for: Lithium carbonate Lithium citrate

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety Study
Official Title:	Pilot Study of Tolerability of Lithium Therapy in Patients With Spinocerebellar Ataxia Type I (SCA1)

Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:

Incidence of side effects, side effect profile, and number of falls.

Secondary Outcome Measures:

ICARS scores, SARA scores, Quantitative Sway/Balance assessment, Tremor Rating Scale scores, dexterity evaluation, sleep questionnaire, Computerized Continuous Performing Tasks assessment

Estimated Enrollment:	15
Study Start Date:	May 2008

Intervention Details:

N/A

Detailed Description:

Objective

Evaluation of tolerability and safety of lithium in SCA1 patients.

Study Population

A total of 10 molecularly diagnosed SCA1 patients divided in two groups. One group would be composed of 5 patients with gait difficulty only and 5 patients with gait difficulty and tremor, hand incoordination or speech difficulties.

Design

Patients will be admitted to the NIH Clinical Center for initiation and titration of Lithium until high therapeutic levels currently accepted for the treatment of Bipolar affective disorder are achieved (1.0-1.2 mmol/L) or a maximum tolerated dose. During their admissions, they will have neurological evaluations, ataxia and tremor evaluations, timed-up-and-go testing, quality of life assessment, questionnaires evaluating sleep, balance confidence and depression, memory testing, alertness assessment and quantitative balance/sway evaluations. Parameters and side effect profiles will be assessed at baseline, 1 month (plus or minus 5 days) and 3 months (plus or minus 5 days) after achievement of therapeutic levels. They will also have an exit evaluation one month (plus or minus 5 days) after discontinuation of Lithium also at the NIH. For their baseline evaluation and titration, patients will be admitted to the NIH for 4 weeks plus or minus 2 weeks. Evaluation at 1 month (plus or minus 5 days) and 3 months (plus or minus 5 days)

Outcome Measures

Primary Outcomes

Incidence of side effects

Side effect profile

Secondary Outcomes

Timed-up-and-go test

ICARS score

SARA score

Modified Falls Efficacy Scale

Quantitative Sway/Balance assessment

Tremor Rating Scale:

Part A - Tremor location/severity rating

Part B -Handwriting and drawings

Part C - Functional disabilities resulting from tremor

Questionnaires related to sleep, depression (Beck Depression Inventory) (BDI), alertness (Computerized Continuous Performing Tasks) and memory (Mini Mental State Examination)

Dexterity evaluation - At-Home Testing Program device

Eligibility

Ages Eligible for Study:	18 Years to 65 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

INCLUSION CRITERIA:
18-65 years of age
Molecularly diagnosed SCA1
Gait disturbance only or gait disturbance and tremor and/or hand incoordination and/or speech difficulty.
Women of childbearing age who agree to use contraceptive methods for the duration of the study.

EXCLUSION CRITERIA:

Children
Pregnant or nursing women
Anyone on a low-sodium diet
Cognitively impaired individuals
Schizophrenics
Family history of thyroid diseases
Patients with medical conditions that can be affected by Lithium such as diabetes mellitus, difficulty urinating, infections (severe occurring with fever, prolonged sweating, diarrhea, or vomiting), kidney disease, epilepsy, thyroid disease, heart disease, pulmonary disease, bipolar affective disorder, cardiac arrhythmia, diabetes insipidus, Parkinson disease, psoriasis and leukemia.
Anyone taking the following medications: diuretics, nonsteroidal anti-inflammatory agents, methyldopa, tetracycline, antipsychotic, neuromuscular blocking agents, digoxin, phenytoin, acetazolamide, calcium iodide, iodinated glycerol, potassium iodide, calcium channel blockers and/or metronidazole. Patients on these medications may be enrolled and their lithium levels will be followed very closely. If levels are consistently maintained, the subject may remain in the study.
Age greater than 65 years

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00683943

Contacts

Contact: Patient Recruitment and Public Liaison Office	(800) 411-1222	prpl@mail.cc.nih.gov
Contact: TTY	1-866-411-1010

Locations

United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike	Recruiting
Bethesda, Maryland, United States, 20892

Sponsors and Collaborators

National Institute of Neurological Disorders and Stroke (NINDS)

More Information

NIH Clinical Center Detailed Web Page This link exits the ClinicalTrials.gov site

Publications:

Allagui MS, Vincent C, El feki A, Gaubin Y, Croute F. Lithium toxicity and expression of stress-related genes or proteins in A549 cells. Biochim Biophys Acta. 2007 Jul;1773(7):1107-15. Epub 2007 Apr 21.

Cummings CJ, Sun Y, Opal P, Antalffy B, Mestril R, Orr HT, Dillmann WH, Zoghbi HY. Over-expression of inducible HSP70 chaperone suppresses neuropathology and improves motor function in SCA1 mice. Hum Mol Genet. 2001 Jul 1;10(14):1511-8.

de Chiara C, Menon RP, Dal Piaz F, Calder L, Pastore A. Polyglutamine is not all: the functional role of the AXH domain in the ataxin-1 protein. J Mol Biol. 2005 Dec 9;354(4):883-93. Epub 2005 Oct 18.

Study ID Numbers:	080134, 08-N-0134
Study First Received:	May 22, 2008
Last Updated:	September 3, 2008
ClinicalTrials.gov Identifier:	NCT00683943
Health Authority:	United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):

Spinocerebellar Ataxia
Lithium
Spinocerebellar Ataxia

Study placed in the following topic categories:

Spinal Cord Diseases
Lithium Carbonate
Central Nervous System Diseases
Brain Diseases
Neurodegenerative Diseases
Dyskinesias
Signs and Symptoms
Cerebellar Ataxia
Heredodegenerative Disorders, Nervous System

Genetic Diseases, Inborn
Ataxia
Neurologic Manifestations
Cerebellar Diseases
Cerebellar ataxia
Spinocerebellar Degenerations
Lithium
Spinocerebellar Ataxias

Additional relevant MeSH terms:

Tranquilizing Agents
Molecular Mechanisms of Pharmacological Action
Nervous System Diseases
Physiological Effects of Drugs
Psychotropic Drugs
Central Nervous System Depressants
Enzyme Inhibitors

Antimanic Agents
Antipsychotic Agents
Pharmacologic Actions
Therapeutic Uses
Central Nervous System Agents
Antidepressive Agents

ClinicalTrials.gov processed this record on January 16, 2009