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CASTLE

Randomised factorial design controlled trial comparing carbamazepine, levetiracetam or active monitoring combined with or withou

CASTLE

Randomised factorial design controlled trial comparing carbamazepine, levetiracetam or active monitoring combined with or withou
Funding NIHR
Portfolio Paediatric, foetal and maternal health
Interventions Medicine,Other
Randomised YES
Status Recruiting
Start Date 01-Aug-2019

Rolandic epilepsy is the most common type of epilepsy. It is also known as ‘benign rolandic epilepsy’, ‘benign childhood epilepsy’ or ‘benign childhood epilepsy with centrotemporal spikes’. Children with rolandic epilepsy have seizures and can often find that their learning, sleep, behaviour, self-esteem and mood are sometimes affected.
Treating epilepsy with medicines to reduce seizures has been the traditional goal of medical treatment for many years. However, just reducing seizures doesn’t necessarily make much difference to the way children and parents feel. The medicines used to treat epilepsy often slow down a child’s thinking and learning. In the past, doctors believed this was an acceptable price to pay to reduce seizures. However, with rolandic epilepsy, where the seizures usually stop in teenage years, we don’t know if it’s better to treat these children with medicines or not, especially if the medicines might have a negative effect on their learning.
As part of standard NHS care, children diagnosed with rolandic epilepsy may be treated with standard antiepileptic medicines like carbamazepine or they receive no medicine at all.
While carbamazepine has been found to be very good at stopping seizures in rolandic epilepsy, it may also slow down thinking and learning. There is an alternative newer medicine called levetiracetam which has also been found to work to reduce seizures in children with rolandic epilepsy. This newer medicine has been shown to cause less problems with thinking and learning in adults and we may find that it has less of an impact on thinking and learning in children too. However, we don’t know if this is true and which of the following three treatment options would be best for children with rolandic epilepsy:
 Carbamazepine (standard medicine treatment)
 Levetiracetam (newer medicine that may be better for thinking and learning)
 No antiepileptic medicine
We want to carry out the CASTLE research study to find this out.
In addition, it has been found that seizures in rolandic epilepsy often happen when a child has had poor sleep and they often occur at night or early in the morning. It has been shown that sleep can be improved through practice without the need of medicines. There are established guidelines to help toddlers go to sleep, but there is nothing available that helps children with epilepsy and their parents improve their sleep quality.
In the CASTLE study, we have developed a sleep training plan for children with epilepsy. Through the CASTLE study we would also like to find out whether following the sleep training plan results in less seizures than using no sleep training at all.