Study to Assess Intracerebroventricular (ICV) Delivery of CT-010 in Subjects With Focal Seizures, With Temporal Lobe Onset With or Without Secondary Generalization
Study to Assess Intracerebroventricular (ICV) Delivery of CT-010 in Subjects With Focal Seizures, With Temporal Lobe Onset With or Without Secondary Generalization
This is a Phase 2 double-blind, randomized, placebo-controlled study to assess the safety and
 efficacy of ICV delivery of CT-010 via an implantable pump and a cranial port and dual lumen
 catheter (CIC) in subjects with focal seizures, with temporal lobe onset with or without
 secondary generalization. Up to 70 subjects will be enrolled. Eligible subjects will be
 randomized in a 1:1 ratio to either CT-010 or placebo treatment. Up to 14 clinical centers
 will be enrolled.
Epilepsy patients that are refractory to oral anti-epileptic drug (AED) treatment have
 significantly higher mortality, higher morbidity, higher economic costs and diminished
 quality of life compared to those who suffer from epilepsy that can be adequately controlled
 with medical management. Current options for refractory patients include neurosurgical brain
 resection, responsive neurostimulation, and vagal nerve stimulation. None of these options is
 satisfactory due to the low applicability of surgery for patients with poorly localized or
 multifocal seizures and the limited success of currently available alternative treatment
 options.

 In this study, patients with medically refractory focal epilepsy will be treated with
 intracerebroventricular (ICV) administration of CT-010, a reformulation of valproate, using
 an implantable drug pump system. This is a randomized, double-blind Phase 2 study evaluating
 the efficacy and safety of this therapy. Clinical assessments, adverse events (AEs), seizure
 diaries, concomitant medications, blood samples and cerebrospinal fluid (CSF) will be
 collected and reviewed at designated time points. Magnetic resonance imaging (MRI) and
 electroencephalography (EEG) will also be performed. Subjects will have their surgery, dose
 changes and pharmacokinetics performed in an inpatient setting.

 Subjects will be enrolled based on Inclusion/Exclusion Criteria and undergo a 6-week baseline
 period confirming and establishing monthly seizure rate. Following the baseline period
 subjects will undergo system implant and a 1-month implant recovery period. Following
 successful implant and recovery subjects will be randomized to either active therapy or
 placebo for a 3-month blinded evaluation period. At the conclusion of the blinded evaluation
 period, subjects will enter an open-label long term follow-up period. Subjects that were
 randomized to placebo will receive active therapy during the open label period.
Inclusion/Exclusion Criteria:

 -

 For a subject to be eligible for this study, he or she must meet ALL of the following
 criteria:

 1. Subject is male or female between the ages of 18 to 70 years old.

 2. Subject is considered an appropriate surgical candidate by the implanting
 Neurosurgeon.

 3. Subject has had confirmed refractory epilepsy for a minimum of 2 years, with
 unilateral or bilateral temporal lobe involvement with no more than 2 known
 extratemporal foci.

 4. In the opinion of the Investigator, subject has disabling seizures.

 5. Subject has had at least one seizure recorded by EEG or video EEG or invasive
 monitoring within the past 3 years consistent with focal temporal lobe seizures (a
 normal interictal EEG is consistent with focal seizures)

 6. Subject has not achieved effective results previously from at least 3 AEDs in single
 or combination. An AED may be counted as failed medication if subject has been on it
 for at least 3-months and is still refractory.

 7. Subject failed to obtain an adequate intake of oral valproate of at least 1,000 mgs a
 day and/or to achieve serum level of at least 60 µg/mL or in the opinion of the
 Investigator is not a candidate for oral valproate (including subject preference)

 8. Per medical history, for the 3 months before informed consent an average of six or
 more disabling focal seizures of temporal lobe onset, with or without secondary
 generalization, per month.

 9. Subject has seizures that are distinct, stereotypical events that can be reliably
 counted, in the opinion of the Investigator, by the subject or caregiver.

 10. Subject understands study procedures and has voluntarily provided signed, informed
 consent in accordance with institutional and local regulatory requirements.

 11. Subject agrees to maintain the diary for the duration of the study alone or with the
 assistance of a competent individual.

 Subjects must NOT meet any of the following Exclusion criteria to be eligible for
 enrollment:

 1. Subject has any neurologic or medical disease that is likely to progress over the
 course of the study and/or would interfere with the study.

 2. Subject has any coagulopathy, ventricular anatomic distortion, or previous brain
 resection.

 3. Subject has history, within 12 months prior to consent, of repetitive seizures that
 cannot be counted with confidence by the subject or competent adult/caregiver.

 4. Subject has history of psychogenic nonepileptic seizures or seizures secondary to
 illicit drug or alcohol use, neoplasia, active central nervous system infection,
 demyelinating disease, degenerative neurological disease, progressive CNS disease or
 metabolic illness.

 5. Subject has had status epilepticus refractory to benzodiazepines and a second agent
 within one year prior to consent

 6. Subject is currently taking neuroleptic medication for behavior control.

 7. Subject has a clear brain anatomic structural related lesion which distorts the normal
 anatomy or interferes with CSF fluid flow.

 8. Subject has required (in addition to low dose stable use of benzodiazepines as part of
 antiepileptic regimen), in the 3 months prior to consent, benzodiazepine use more than
 5 times per month for rescue seizure control. One use is defined as taking up to 3
 doses in a 24-hour period.

 9. Subject is currently implanted with an activated DBS, or RNS device used for treatment
 of a neurologic or psychiatric condition.

 10. Subject currently has VNS and the VNS stimulation parameters are not stable. Stable
 shall be defined such that the stimulation parameters have not been changed in the
 last 3 months or the patient/designee is able to report "magnet swipe" during the same
 time period. The Investigator believes that the continued stable parameters can be
 maintained through the Primary Evaluation Period.

 11. Subject has had more than 10 seizures in one day or more than 200 seizures in one
 month within last year.

 12. Subject has known allergy to citrate, citric acid, valproic acid, divalproex sodium,
 any components of CT-010, or Depacon®.

 13. Subject has unstable depression being treated with more than 1 antidepressant
 medication or has current evidence of or history within the past 2 years of DSM-IV
 criteria for any major psychiatric disorder including psychosis, major depression,
 bipolar disorder, and has had a suicide attempt within the previous five years. Also
 excluded are subjects with a history of prolonged postictal psychosis or psychosis or
 depression secondary to a discontinued AED.

 14. In the opinion of the Investigator, the subject has a clinically significant or
 unstable medical condition (e.g., uncontrolled diabetes or CHF) or a progressive CNS
 disease that would limit the subject's entry into the study