The goal of this clinical trial is to find out whether two existing medications-anakinra and tocilizumab-can effectively treat a rare and life-threatening brain condition called NORSE (New-Onset Refractory Status Epilepticus). NORSE causes continuous seizures in previously healthy children and adults and does not respond to standard treatments. It often leads to long-term disability or death. Doctors currently use anakinra and tocilizumab as second-line treatments when first-line therapies fail, but there is no clear evidence showing which drug works better or when it should be given. This study aims to answer those questions. The study will enroll patients across 33 hospitals in the United States, Canada, Europe, and Asia. It includes two groups: 1. Randomized Cohort Patients will be randomly assigned to receive either anakinra or tocilizumab within the first 7 days of their illness. Only patients whose doctors were already planning to use one of these medications as part of standard care will be eligible for randomization. Researchers will monitor their recovery and compare outcomes between the two treatments. 2. Observational Cohort Patients who cannot be randomized-usually because they were diagnosed too late-will still be followed to study how the timing of treatment affects recovery. Participants will: * Receive one of the two medications (depending on their group assignment). * Take part in follow-up assessments over the course of one year, including medical evaluations and surveys. Some participants may be followed annually beyond one year. * Optionally participate in a 60-minute interview to share their or their caregiver's experience with NORSE.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
438
SOC will be followed , Suggested Dose: 10 mg/kg/day IV, divided into 4 daily doses (q6h) Maximum dose: 400 mg/day
SOC will be followed, Suggested Dose: If \<30 kg: 12 mg/kg IV once every 2 weeks If ≥30 kg: 8 mg/kg IV once every 2 weeks Maximum dose: 800 mg per dose
For patients who could not be randomized by day 7, standard clinical care will be followed and patients will be followed prospectively and observationally.
Barrow Institute
Phoenix, Arizona, United States
Children's Hospital Colorado
Aurora, Colorado, United States
Yale New Haven Hospital
New Haven, Connecticut, United States
Children's National (DC)
Washington D.C., District of Columbia, United States
University of Florida
Gainesville, Florida, United States
Glasgow Outcome Scale - Extended (GOS-E)
The Glasgow Outcome Scale - Extended (GOS-E) is an 8-point scale used to measure global functional outcome. Participants are scored into one of the 8 categories: 1. Death, 2. Vegetative State, 3. Lower Severe Disability, 4. Upper Severe Disability, 5. Lower Moderate Disability, 6. Upper Moderate Disability, 7. Lower Good Recovery, 8. Upper Good Recovery.
Time frame: 12 months
Time to resolution of status epilepticus (SE)
Time (days) until discontinuation of anesthetic drips for 24h for the treatment of SE with no return of SE on EEG
Time frame: 24 hours off anesthetic drips
Hospital length of stay
Mean number of days during hospitalization from admission to discharge
Time frame: 12 months
Mortality
Mortality, number of participants
Time frame: up to 12 months
Number of serious adverse events attributed to anakinra or tocilizumab
Number of serious adverse events attributed to anakinra or tocilizumab
Time frame: From hospitalization to 1 month after stopping treatment, up to 12 months
Number of participants Post-NORSE epilepsy
Number of participants with any unprovoked seizures after hospital discharge
Time frame: 12 months
Number of participants with Treatment success
Combined measure of lack of need for another immunomodulator after the study drug was begun, plus good outcome at 1 year (GOS-E of 5-8) (Yes/No)
Time frame: 12 months
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University of Chicago
Chicago, Illinois, United States
Northwestern University
Evanston, Illinois, United States
Mass General (MGH)
Boston, Massachusetts, United States
Beth Israel Deaconess
Boston, Massachusetts, United States
Boston Children's Hospital
Boston, Massachusetts, United States
...and 23 more locations