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ESOC 2025 | EAST trial: levetiracetam & head positioning for suspected stroke in the ambulance

Lili Song, MD, PhD, University of New South Wales, Kensington, Australia, discusses the Phase III EAST trial (NCT06773364), a factorial study evaluating the effectiveness of levetiracetam and head positioning in the ambulance for patients with suspected stroke. Dr Song outlines the trial’s two-by-two design, in which patients are randomized to receive levetiracetam or not, and to be positioned either sitting up or lying flat. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.

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Transcript

Yeah, you know, actually, EAST study is a factorial study. Yeah, so we put two study factors into this trial. The first one is keppra, you know, it’s an anti-seizure drug, a very old drug, however, it has been used in normal practice, very common, and it has been proven it’s safe. And there is a randomized trial before has proven it has done benefits for patients with intracerebral hemorrhage because it reduces the rate of epileptic seizures...

Yeah, you know, actually, EAST study is a factorial study. Yeah, so we put two study factors into this trial. The first one is keppra, you know, it’s an anti-seizure drug, a very old drug, however, it has been used in normal practice, very common, and it has been proven it’s safe. And there is a randomized trial before has proven it has done benefits for patients with intracerebral hemorrhage because it reduces the rate of epileptic seizures. And in some preclinical studies, we also found it has some potential neuroprotective effect. So we designed the first arm is to determine the safety and effectiveness of using keppra in the ambulance. The second arm is related to head position. Our team previously has conducted a trial called the head post. It has proven after hospital admission for stroke patients, actually there is no big difference, significant difference between two head positions. One is lying down, one is sitting up, no difference. However, we want to know whether which head position is more beneficial for the patient. So the second arm, we want to explore the optimal head position in the ambulance. So we designed two factorial trials for this EAST trial. So in the ambulance we will randomize patients to four groups because it’s factorial. So for the first arm it will be randomized to receive either keppra or not and for head position arm we will randomize the patient into either sitting up or lying down. So that’s our design.

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Disclosures

I am the co-PI for INTERACT4 and EAST trial.