Trial of Melatonin to Improve Sleep in Children With Epilepsy and Neurodevelopmental Disabilities

The Hospital for Sick Children

Status and phase

Completed

Phase 3

Conditions

Epilepsy

Insomnia

Developmental Disability

Treatments

Drug: Fast Release Placebo

Drug: Fast Release Melatonin (FR MLT)

Drug: Timed Release Melatonin (TR MLT)

Drug: Timed Release Placebo

Study type

Interventional

Funder types

Other

Identifiers

NCT01161108

1000010842

Details and patient eligibility

About

The purpose of the study is to evaluate the safety and efficacy of oral melatonin in improving sleep continuity in children with epilepsy and neurodevelopmental delay who have chronic insomnia by comparing Fast Release Melatonin (FR MLT) to placebo and Timed Release Melatonin (TR MLT) with placebo in a randomized cross-over design trial.

Full description

Sleep disturbance in children is a universal concern. The prevalence of sleep disorders may be as high as 80% in children with neurodevelopmental disabilities. The majority of the parental complaints are with difficulty getting children to settle to sleep at night and stay asleep (insomnia).

Two recent studies comparing children with epilepsy to matched controls or to sibling controls both concluded that children with epilepsy have more daytime sleepiness that may be due to underlying sleep disorders, and significantly greater sleep problems than their non-epileptic peers.

Endogenous melatonin is thought to synchronize the sleep-wake pattern with the light-dark cycle of the normal day. Exogenous melatonin has been found to be effective in reducing sleep onset latency, increasing sleep duration, and increasing sleep efficiency in a meta-analysis of subjects with sleep disorders. The melatonin in fast release preparations is released quickly and has a short half-life of less than 1 hour. It is most helpful in decreasing sleep onset latency (the time to fall asleep). The melatonin in timed release tablets is released in a slower more sustained way and, in a small study in children with severe neurodevelopmental disabilities, was more useful for sleep maintenance.

Fast release melatonin has been shown to be effective in a study of children with multiple disabilities and in one trial in children with epilepsy. Further rigorous evaluation of melatonin is needed as the validity of these studies is limited by their lack of blinding, small sample sizes, and subjective methods of sleep-wake outcome evaluations.

Enrollment

13 patients

Sex

All

Ages

5 to 17 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Children aged 5-17 years
Children with epilepsy with at least 2 partial or generalized seizures per month over the last 3 months prior to starting the trial
Children with neurodevelopmental disability, i.e. significant delay in development requiring special educational setting or educational assistant
Anti-epileptic drugs (AED's) expected to remain unchanged for duration of trial (14 weeks)
Not currently using melatonin or any other medication for sleep Subjects will be eligible if they have previous use of melatonin as long as there is a washout period of at least 1 week. Similarly, children taking natural health products for sleep will be included as long as there is a 30 day washout period prior to study enrollment.
Chronic insomnia - reported by parent(s) to include one of the following: sleep onset latency of greater than one hour, duration of sleep less than 8.5 hours per night with either/or both these problems occurring at least 3 nights per week and that have occurred 3 months prior to trial, or night wakings of more than 2 per night for same time period

Exclusion criteria

Planned epilepsy surgery or change in AED's during treatment trial
Sleep disturbances that are treatable such as obstructive sleep apnea
Allergy or severe adverse effects to melatonin
Allergy or severe adverse effects to any of the ingredients of the study product or placebo (e.g. lactose)
Lactose intolerance
Pregnant
Breastfeeding
Known liver disease
Ketogenic diet
Other drugs being used for sedation
Immunosuppressive drugs
Known blood clotting abnormalities or who are on anticoagulant therapy (e.g. warfarin, blood thinners)

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Crossover Assignment

Masking

Single Blind

13 participants in 2 patient groups

Group A: Fast Release Melatonin

Active Comparator group

Description:

Subjects will be randomized to one of the two treatment arms and to the order of study medication v.s. placebo. The subject will undergo the assigned treatment for 7 weeks (3 weeks of study drug, a one week wash-out and 3 weeks of placebo, or vice versa).

Treatment: