Purpose

Neurofibromatosis Type 1 (NF1) is a common genetic disorder that is associated with a four times greater risk of learning disabilities, including reading disabilities, and a deficiency of neurofibromin - a protein important in a signaling pathway that regulates learning and memory. Our previous work (NS49096) demonstrated that school-age children with NF+RD can respond to standard phonologically-based reading tutoring originally developed to treat reading disability in the general population. Combining our work with that by other researchers suggesting that a medication (Lovastatin) may counteract the effects of the deficient neurofibromin, and possibly ameliorate learning disabilities in NF1, the investigator propose to examine the synergistic effects of medication plus reading tutoring.

Conditions

Eligibility

Eligible Ages
Between 8 Years and 20 Years
Eligible Genders
All
Accepts Healthy Volunteers
Yes

Criteria


Inclusion Criteria:

This study will be open to all English speakers who meet eligibility criteria regardless of
race, gender, minority or socioeconomic status. Inclusion criteria to be met are listed
below:

1. Individuals ages 8-20 (all participants)

2. Documented NF-1 (NF patients only)

3. If female, participant is post-menarche (NF patients only)

4. If male, participant has reached Tanner Stage 2 (NF patients only)

5. Participant able to swallow capsule (NF patients only, may be confirmed via
swallowability test, described below)

6. Participant's English is sufficient for school (all participants)

7. Participant must either answer "yes" to question A, or answer "yes" to at least 2
items for questions B-D listed below:

A. Has your child ever been diagnosed with a reading disability? B. Did your child have
trouble learning how to "sound out" words? C. Have you (parent) ever been concerned about
your child's reading ability? D. Did the school or teacher ever express any concerns about
your child's reading ability? Swallowability Assessment: We may ask patients to perform a
capsule swallowability assessment prior to enrollment. We will ask subjects to attempt to
swallow an empty capsule, matching the same size of the Lovastatin 20mg and 40mg capsules
to be used in the study, to confirm swallowability. Patients will be provided with up to 2
capsules as needed to successfully perform the swallowability assessment. If the patient is
unable to swallow the capsule, enrollment in the study may deferred or declined.

A child will be excluded if he/she meets any of the following criteria, which will be
determined by initial telephone screening as well as review of medical/developmental
history prior to and during testing:

1. Child 7 years of age or less;

2. known uncorrectable visual impairment;

3. documented hearing impairment greater than or equal to a 25 dB loss;

4. medical contraindication to MRI procedures (e.g., metal devices);

5. any psychiatric, behavioral, or developmental disorder that would preclude active
participation in in-depth tutoring sessions

6. Pregnant at time of screening.

7. Known conditions which are contraindicated to Lovastatin

1. Hypersensitivity to the medication

2. Uncontrolled Epilepsy

3. Metabolic Syndrome X, High Blood Sugar,

4. Muscle Damage Due to Autoimmunity

5. Stroke caused by Bleeding in the Brain, Loss of Memory,

6. Severely Low Blood Pressure

7. Liver Problems including Abnormal Liver Function Tests

8. Severe Renal Impairment,

9. Serious Muscle Damage that may Lead to Kidney Failure,

10. Recent Operation or significant Injury

11. Muscle Pain or Tenderness with Increase Creatinine Kinase,

12. Habit of Drinking Too Much Alcohol

13. Pregnant or lactating. - Lovastatin is contraindicated during pregnancy and in
nursing mothers because it decreases synthesis of cholesterol and other products
of the cholesterol biosynthesis pathway that are essential components for fetal
development.

Children who meet criteria for ADHD, Oppositional Defiant Disorder, adjustment disorder,
and/or mild depression will be eligible as long as they are not taking psychotropic
medications, with the exception of stimulant medication for ADHD.

For pilot participants only:

Criteria for inclusion/exclusion for pilot participants is outlined below. Children who
meet criteria for ADHD, Oppositional Defiant Disorder, adjustment disorder, and/or mild
depression will be eligible as long as they are not taking psychotropic medications, with
the exception of stimulant medication for ADHD.

1. Children ages 8-17

2. Participant is a native English speaker

3. Participant must either answer "yes" to question A, or answer "yes" to at least 2
items for questions 2-4 listed below:

A. Has your child ever been diagnosed with a reading disability? B. Did your child have
trouble learning how to "sound out" words? C. Have you (parent) ever been concerned about
your child's reading ability? D. Did the school or teacher ever express any concerns about
your child's reading ability?

A child will be excluded if he/she meets any of the following criteria, which will be
determined by initial telephone screening as well as review of medical/developmental
history prior to and during testing:

1. Children 7 years of age or younger

2. previous diagnosis of Intellectual Disability;

3. known uncorrectable visual impairment;

4. documented hearing impairment greater than or equal to a 25 dB loss;

5. medical contraindication to MRI procedures (e.g., metal devices);

6. known IQ below 70;

7. a pervasive developmental disorder; and

8. any known neurologic pathology, including epilepsy, spina bifida, cerebral palsy,
traumatic brain injury, optic gliomas, and brain tumors (other than UBOs).

9. Comorbid severe psychiatric disorders will also be excluded.

Study Design

Phase
Phase 2
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
Triple (Participant, Care Provider, Investigator)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
NF1: Lovastatin + reading tutoring
Participants (NF-1 patients) will receive 20mg of Lovastatin per day for the first two weeks, the dose will be escalated 40 mg for the remaining 11 weeks. And one week of intensive, one-on-one reading tutoring intervention
  • Drug: Lovastatin
    Those in the Lovastatin group will receive 20mg of Lovastatin per day for the first two weeks and 40mg of Lovastatin per day starting at week 3 through week 11.
  • Behavioral: reading tutoring intervention
    After the initial 12 weeks of Lovastatin or placebo, children will return for one week of intensive, one-on-one tutoring intervention (either reading or sham; Visit 2)
Placebo Comparator
NF1: Placebo + reading tutoring
Participants (NF-1 patients) will receive placebo daily And one week of intensive, one-on-one reading tutoring intervention
  • Behavioral: reading tutoring intervention
    After the initial 12 weeks of Lovastatin or placebo, children will return for one week of intensive, one-on-one tutoring intervention (either reading or sham; Visit 2)
  • Drug: Placebo Oral Tablet
    Those in the placebo group will receive a tablet daily
Placebo Comparator
RD: Reading tutoring
Participants (RD-only participants) will receive one week of intensive, one-on-one reading tutoring intervention
  • Behavioral: reading tutoring intervention
    After the initial 12 weeks of Lovastatin or placebo, children will return for one week of intensive, one-on-one tutoring intervention (either reading or sham; Visit 2)
Sham Comparator
RD: Other Academic (sham) tutoring
Participants (RD-only participants) will receive one week of intensive, one-on-one tutoring intervention with an academic focus other than reading. These participants will have the opportunity to receive reading tutoring upon finishing study participation.
  • Behavioral: Other Academic "sham" tutoring
    No reading (sham) tutoring. Children will receive intensive tutoring on a subject other than reading.

Recruiting Locations

Vanderbilt University
Nashville, Tennessee
Contact:
Laura E. Cutting
615-875-1054

More Details

NCT ID
NCT02964884
Status
Recruiting
Sponsor
Vanderbilt University

Study Contact

Julie Delheimer, BS
615-875-5534
educationbrain@vanderbilt.edu

Detailed Description

Neurofibromitosis Type 1 (NF1) is a common autosomal dominant neurocutaneous syndrome. The most common concern of NF1 is learning disabilities (LDs). Approximately half of children with NF1 have LDs, the most common of which are reading disabilities (RDs).The purpose of this research is to gain a deeper understanding of the characteristics and treatment of RDs in NF1.

The Investigator will evaluate four different groups (see list below) to determine if there are differential outcomes in these groups of children with NF+RD. The first two groups will consist of NF1 patients, and the second two groups will consist of participants with RDs but without NF1.

1. Reading tutoring program and a medication called Lovastatin (NF1 patients)

2. Reading tutoring program and no Lovastatin (placebo) (NF1 patients)

3. Reading tutoring program (RD participants)

4. Other Academic "Sham" tutoring (eligible to receive reading tutoring after study participation is complete) (RD participants)

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.