Open label, phase II study non randomized single group assignment of 20 evaluable patients 13 years and older, over 37,5 kg body-weight, with sensorineural hearing loss of at least 20 dB at 8 kHz in high frequency average (HFA), and with documented genetic mutations in the WFS1 gene and with at least one other major documented clinical symptom pertaining to Wolfram syndrome (i.e. diabetes mellitus, diabetes insipidus, optic atrophy). Every patients will receive over three years a treatment by VPA (Depakine chrono).
Open label, phase II study non randomized single group assignment of 20 evaluable patients 13 years and older, over 37,5 kg body-weight, with sensorineural hearing loss of at least 20 dB at 8 kHz in high frequency average (HFA), AND with documented genetic mutations in the WFS1 gene AND with at least one other major documented clinical symptom pertaining to Wolfram syndrome (i.e. diabetes mellitus, diabetes insipidus, optic atrophy). Every patients will receive over three years a treatment by VPA (Depakine chrono). The effective dose and duration of this 3 years therapy has to be determined individually with the aim to obtain preservation of auditory function defined as no decrease higher than 5 dB on one ear compared to baseline at 8 kHz on high frequencies average and to reduce the dose of insulin and/or desmopressin needed, therefore monitoring of the patients plasma concentration of VPAis required for dose adjustment. Generally a plasma level between 40 and 100 mg/l (ie, 300 to 700 micromol/l) sodium valproate is aimed to be reached. Initially 10-15 mg of sodium valproate/kg bodyweight per day will be taken in one or two doses during meals. The dose will then be increased every 3 days in steps of 10 mg sodium valproate/kg bodyweight per day till the optimal plasma level is reached but does not exceed 100 milligrams per liter (ie, 700 micromol/l) during 156 weeks (refer to Appendix 5). Analysis will compare Pure tone audiometry (PTA), Speech interference index (SII) and High frequency pure tone audiometry hearing test between baseline and final visit.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
Refer to arm description.
HEGP
Paris, France
RECRUITINGCentro periférico de Especialidades de Almería
Almería, Spain
RECRUITINGPreservation of auditory function.
Preservation of auditory function defined as no decrease higher than 5 dB in hearing at 8 kHz in high frequency average (HFA) over three years in patients with Wolfram syndrome with a deficit of at least 20d dB at 8 kHz treated with VPA at optimal dose corresponding to the plasma level between 40 and 100 mg/l (ie, 300 to 700 micro mol/l).
Time frame: Baseline - Week 156
Safety endpoint
Overall incidence of adverse events and serious adverse events as well as laboratory assessments will be evaluated for each group and for the study as a whole.
Time frame: Baseline - Week 156
Ventral Pons Volume measure
Ventral Pons Volume measured and recorded in mm3 by standardised analysis of MRI at baseline, at visit 8 (Week 52) and at the final visit.
Time frame: Baseline - Week 156
Insulin and or desmopressin requirements
Insulin and or desmopressin requirements will be assessed whenever the patient is under one or both treatments in order to document potential benefit from VPA on diabetes mellitus or diabetes insipidus
Time frame: Baseline - Week 156
Visual acuity assessment
Visual acuity will be assessed using standard ETDRS measures and visual field recording at baseline, every six months during the first year of follow-up and at the final visit
Time frame: Baseline - Week 156
Retinal nerve thikness measure
Retinal nerve thikness measured by OCT measures at baseline, every six months during the first year of follow-up and at the final visit
Time frame: Baseline - Week 156
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NONE
Enrollment
23
Balance measured by Mini-BESTest
Balance, measured by Mini-BESTest (Appendix 1) at baseline, at visit 8 (Week 52) and at the final visit.
Time frame: Baseline - Week 156
Quality of sleep assessment on pediatric population - Qualitative questionnaire (no scale)
Sleep will be investigated by Pediatric Sleep Questionnaire at baseline, at visit 8 (Week 52) and at final visit.
Time frame: Baseline - Week 156
Quality of sleep assessment on adult population - Qualitative questionnaire (no scale)
Sleep will be investigated by Pittsburg Sleep Quality Index Self-Report on adult population at baseline, at visit 8 (Week 52) and at final visit.
Time frame: Baseline - Week 156