Propranolol Adjuvant Treatment of Focal Refractory Epilepsy (PATFRE)

Prior treatment

• Currently treated with a beta adrenergic receptor antagonist or Previously used within 12 months
• Alcohol abuse or drug misuse within 2 years prior to medication.

Other illness

• Diagnosed with generalized or hereditary epilepsy with ion channel gene mutations
• Psychogenic non-epileptic seizures within 12 months;
• Treatable causes of epilepsy (such as metabolic disorders, toxicity, infections, space-occupying lesions, or identified genetic abnormalities)
• Patients with only non-motor focal seizures, as classified by the 2017 ILAE.
• Seizure clusters within the 12 months.
• Free of major medical illnesses including:
• Cardiac diseases (history of cardiac valve disease, coronary artery disease, congestive heart failure, A-V block, peripheral vascular disease, any cardiac arrhythmia/bradycardia)
• Histories of asthma, bronchospastic disease, or obstructive pulmonary disease
• Severe allergic reactions to medications which are included in the beta blocker family
• Immunodeficiency disorders, liver or kidney diseases, acute infections, or advanced-stage tumors.
• Participants with a history of medical conditions or surgeries that, in the investigator's judgment, could affect the absorption, distribution, or metabolism of the study drug (e.g., active peptic ulcers, ulcerative colitis, Crohn's disease, or bowel obstruction) or those with difficulty swallowing.
• Participants with any medical condition, mental health status, cognitive impairment, or intellectual disability that the investigator believes could increase the risk to the participant or interfere with their ability to participate in the clinical trial.

Lab values

• Uncontrolled Diabetes (HbA1c of ≤ 8 if previously tested)
• Participants meeting any of the following laboratory criteria: alanine aminotransferase (ALT) \>2× upper limit of normal (ULN), aspartate aminotransferase (AST) \>2× ULN, alkaline phosphatase (ALP) \>2× ULN, platelet count \<80×10\^9/L, neutrophil count \<1.8×10\^9/L, or creatinine clearance (CLcr) \<30 mL/min (calculated by the Cockcroft-Gault formula).

Other

• Tonic-clonic status epilepticus within12 months.
• Uncontrolled hypotension
• In the period of pregnancy, childbirth, lactation.
• Participation in another clinical study within 3 months;

• 18-60 years of age.
• Meet the 2017 International League Against Epilepsy (ILAE) diagnostic criteria for for focal seizures or focal seizures progressing to bilateral tonic-clonic seizures.
• Diagnosed with refractory epilepsy, having used at least two AEDs without effectiveness for 2 years. No drug interaction between current AEDs and propranolol, and a stable dose for at least 12 weeks prior to enrollment.
• Seizure duration ≥1 minute, with accompanying sensory impairment.
• At least 6 focal seizures within the 12 weeks preceding enrollment.
• EEG or MRI/CT results within the past 2 years, confirming the diagnosis of focal epilepsy.
• The use of vagus nerve stimulation (VNS) and deep brain stimulation (DBS) is permitted, need to implant at least 5 months and stable for at least 12 weeks before enrollment.The parameters should keep unchanged until the end of the study.
• Informed consent signed.