Clinical Trial Characterizing the Bioavailability of 1-Octanol in Adults With Ethanol-responsive Essential Tremor
Clinical Trial Characterizing the Bioavailability of 1-Octanol in Adults With Ethanol-responsive Essential Tremor
OVERVIEW

 Essential tremor (ET) is a common movement disorder affecting 0.4% of the general population
 and up to 14% of people 65 years and older. Response to medications such as beta blockers and
 primidone may be of benefit, but are often accompanied by intolerable side effects. Response
 to ethanol, on the other hand, has a roughly 80% chance of significant tremor reduction,
 though daily use of this as a treatment has potentially serious medical, social, and legal
 consequences.

 The leading hypothesis for ET pathophysiology is an unmasking of spontaneous oscillations
 originating in neurons of the inferior olive. Both ethanol and 1-octanol have been shown to
 reduce these spontaneous oscillations in an animal model of ET; however, 1-octanol does this
 at a dose much lower than that leading to intoxication, suggesting in may be useful in the
 treatment of essential tremor. Our initial studies with 1-octanol have shown it to be safe at
 dosages up to 64mg/kg without signs of intoxication, while at the same time showing benefit.

 OBJECTIVE

 We plan to evaluate the efficacy of different 1-octanol formulations in humans based on
 accelerometry and spirography. We will also evaluate drug and metabolite bioavailabilities
 using a high performance liquid chromatography (HPLC) detection method from plasma and urine
 samples.

 STUDY POPULATION

 We will study adult subjects with ethanol-responsive Essential Tremor (ET).

 DESIGN

 This study is designed as a two-phase unblinded inpatient study of adults with ET receiving
 weight-adjusted oral dosages of 2 different formulations of 1-octanol in a crossover fashion.
 Phase I of the study is designed to develop an octanol detection assay using HPLC. Four
 subjects will receive daily escalating dosages (1-32 mg/kg) of a single 1-octanol formulation
 followed by a crossover trial of both formulations at a dosage of 64 mg/kg. Phase II will
 study 20 subjects receiving one of the two formulations at 64 mg/kg on inpatient day 1
 followed by a 24 hour period of close monitoring. The second formulation will be given on day
 3 and the patient will again undergo close monitoring for 24 hours.

 OUTCOME MEASURES

 The primary outcome measures for the study will be efficacy based on tremor ratings from
 accelerometry and spirography. Secondary outcome measures will be the determination of
 bioavailability, pharmacodynamic and pharmacokinetic profiles of octanol #61864 and octanol
 #68751 and their metabolites.
OVERVIEW

 Essential tremor (ET) is a common movement disorder affecting 0.4% of the general population
 and up to 14% of people 65 years and older. Response to medications such as beta blockers and
 primidone may be of benefit, but are often accompanied by intolerable side effects. Response
 to ethanol, on the other hand, has a roughly 80% chance of significant tremor reduction,
 though daily use of this as a treatment has potentially serious medical, social, and legal
 consequences.

 The leading hypothesis for ET pathophysiology is an unmasking of spontaneous oscillations
 originating in neurons of the inferior olive. Both ethanol and 1-octanol have been shown to
 reduce these spontaneous oscillations in an animal model of ET; however, 1-octanol does this
 at a dose much lower than that leading to intoxication, suggesting it may be useful in the
 treatment of essential tremor. Our initial studies with 1-octanol have shown it to be safe at
 dosages up to 64mg/kg without signs of intoxication, while at the same time showing benefit.

 OBJECTIVE

 We plan to evaluate the efficacy of different 1-octanol formulations in humans based on
 accelerometry and spirography. We will also evaluate drug and metabolite bioavailabilities
 using a high performance liquid chromatography (HPLC) detection method from plasma and urine
 samples.

 STUDY POPULATION

 We will study adult subjects with ethanol-responsive Essential Tremor (ET).

 DESIGN

 This study is designed as a two-phase unblinded inpatient study of adults with ET receiving
 weight-adjusted oral dosages of 2 different formulations of 1-octanol in a crossover fashion.
 Phase I of the study is designed to develop an octanol detection assay using HPLC. Four
 subjects will receive daily escalating dosages (1-32 mg/kg) of a single 1-octanol formulation
 followed by a crossover trial of both formulations at a dosage of 64 mg/kg. Phase II will
 study 20 subjects receiving one of the two formulations at 64 mg/kg on inpatient day 1
 followed by a 24 hour period of close monitoring. The second formulation will be given on day
 3 and the patient will again undergo close monitoring for 24 hours.

 OUTCOME MEASURES

 The primary outcome measures for the study will be efficacy based on tremor ratings from
 accelerometry and spirography. Secondary outcome measures will be the determination of
 bioavailability, pharmacodynamic and pharmacokinetic profiles of octanol #61864 and octanol
 #68751 and their metabolites.

 Addendum: Based on the results of the assays for all subjects who participated in Part 1 and
 2 of this protocol, we would like to conduct an exploratory study (Part 3) consisting of two
 subjects receiving a dose of 128mg/kg of 1-octanol. This is meant to primarily explore the
 plasma concentration of 1-octanol, while also providing valuable information regarding the
 safety and efficacy at this higher dose. The remainder of the experimental design will be
 maintained, with exception of additional safety precautions which will be discussed in the
 protocol and consent.
INCLUSION CRITERIA:

 -  Patients with alcohol-responsive Essential Tremor

 -  Limb involvement should be a prominent feature of the Essential tremor

 -  Patients must be willing and able to safely stop and remain off any medications used
 to treat essential tremor for at least 4 half-lives

 -  Patients must be willing to abstain from ethanol and caffeine intake for at least 48
 hours prior to starting the study hospitalization until study termination

 -  Patients must be willing and able to fast for periods of up to 12 hours during the
 study

 EXCLUSION CRITERIA:

 -  Patients with abnormalities other than tremor on neurological exam

 -  Patients with active or past alcohol abuse or dependence

 -  Patients with acute or chronic severe medical conditions such as renal failure,
 hepatic failure or lung disease

 -  Patients taking primidone

 -  Patients on other acute or chronic medications that influence hepatic metabolism or
 central nervous system (CNS) function and cannot be temporarily discontinued for the
 length of the study

 -  Patients who do not wish to take a potentially intoxicating drug

 -  Patients with abnormalities on their baseline screening laboratory tests

 -  Women who are pregnant or lactating

 -  Patients younger than age 21

 -  The presence of cognitive impairment preventing informed consent or cooperation during
 the study

 -  People of Far East Asian or Native American descent, who may possess variant alleles
 of the genes for alcohol metabolism, i.e., alcohol dehydrogenase and aldehyde
 dehydrogenase, resulting in altered (slower) metabolism and potentially increased
 sensitivity to alcohols and their metabolites