Spinal Cord Stimulation for Gait in Parkinson Disease

NCT ID: NCT03079310

Last Updated: 2020-06-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

15 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-02-29

Study Completion Date

2022-04-30

Brief Summary

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Balance and gait impairment increases the risk of falls and contributes to a reduced quality of life and shorter survival in Parkinson disease (PD) and atypical Parkinsonism patients. In preliminary case studies, electrical epidural spinal cord stimulation (SCS) has been shown to significantly improve gait, postural instability, rigidity, and tremor. Controlled studies for optimizing which stimulation settings produce the best clinical response for mobility and gait, and achieving these results chronically are all significant unmet needs. Using quantitative laboratory and mobile technologies to test a range of stimulation settings, this research study aims to determine which SCS parameters or combination of parameters is best suited to effectively alleviate disabling symptoms experienced by each patient.

Detailed Description

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Conditions

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Parkinson Disease Atypical Parkinsonism

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Spinal cord stimulation

Boston Scientific SCS system

Group Type EXPERIMENTAL

Spinal cord stimulation

Intervention Type DEVICE

Range of pulse widths (200-500 microseconds) and frequencies (30-130 Hz) will be assessed for each patient

Interventions

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Spinal cord stimulation

Range of pulse widths (200-500 microseconds) and frequencies (30-130 Hz) will be assessed for each patient

Intervention Type DEVICE

Other Intervention Names

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Boston Scientific PrecisionĀ® System

Eligibility Criteria

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Inclusion Criteria

* Consenting male and female participants, aged 18 years to 80 years
* Idiopathic PD with II-IV Hoehn-Yahn stage
* A history of frequent falls, gait and balance dysfunction and postural instability
* ON-freezing
* Ability to perform a gait/walking task (under close supervision),
* PD participants referred by Dr. Jog to the functional neurosurgeon for SCS implantation for treatment of their gait and balance dysfunction and/or for their freezing of gait.
* SCS eligibility has been confirmed by neurologist and neurosurgeon
* Patients who receive SCS for their gait and mobility must participate in this study in order to determine which SCS parameters provide the patient with the best outcome for their PD symptoms.
* able to give informed consent
* Able to attend all clinic visits and assessments
* No dementia or psychiatric abnormalities on neuropsychological testing
* No significant secondary causes (such as cerebrovascular disease, normal pressure hydrocephalus, peripheral neuropathy, severe degenerative lower limb or back disease).

* we had a few devices to include exploratory trial in atypical PD (MSA, PSP, and CBD confirmed diagnosis from clinic).

Exclusion Criteria

* History of stroke

* History of ALS or Myasthenia Gravis
* Offending medications (Lithium, valproate, steroids, amiodarone, beta-adrenergic agonists (e.g. salbutamol).
* Persons prescribed zonisamide
* Women reporting that they are pregnant
* Persons medically unstable with contraindications to SCS will be excluded
* Previous brain surgery or cardiac pacemaker
* Eligibility for deep brain stimulation surgery
* Moderately severe parkinsonism in the context of unstable pharmacological treatment
* Dementia as assessed by DSM criteria or severe cognitive disturbances
* Severe psychiatric symptoms (in particular, hallucinations and depression)
* Bad general health
* Lack of compliance at follow-up
* Severe dyskinesias
* Significant cognitive impairment
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Western University, Canada

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mandar Jog, MD

Role: PRINCIPAL_INVESTIGATOR

LHSC

Locations

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London Health Sciences Centre

London, Ontario, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Mandar Jog, MD

Role: CONTACT

519-685-8500 ext. 76708

Olivia Samotus, MSc

Role: CONTACT

519-685-8500 ext. 32059

Facility Contacts

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Mandar Jog, MD

Role: primary

519-685-8500 ext. 32758

References

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Fuentes R, Petersson P, Nicolelis MA. Restoration of locomotive function in Parkinson's disease by spinal cord stimulation: mechanistic approach. Eur J Neurosci. 2010 Oct;32(7):1100-8. doi: 10.1111/j.1460-9568.2010.07417.x.

Reference Type BACKGROUND
PMID: 21039949 (View on PubMed)

Santana MB, Halje P, Simplicio H, Richter U, Freire MAM, Petersson P, Fuentes R, Nicolelis MAL. Spinal cord stimulation alleviates motor deficits in a primate model of Parkinson disease. Neuron. 2014 Nov 19;84(4):716-722. doi: 10.1016/j.neuron.2014.08.061. Epub 2014 Oct 30.

Reference Type BACKGROUND
PMID: 25447740 (View on PubMed)

Jenkinson N, Nandi D, Muthusamy K, Ray NJ, Gregory R, Stein JF, Aziz TZ. Anatomy, physiology, and pathophysiology of the pedunculopontine nucleus. Mov Disord. 2009 Feb 15;24(3):319-28. doi: 10.1002/mds.22189.

Reference Type BACKGROUND
PMID: 19097193 (View on PubMed)

Nagatsua T, Sawadab M. L-dopa therapy for Parkinson's disease: past, present, and future. Parkinsonism Relat Disord. 2009 Jan;15 Suppl 1:S3-8. doi: 10.1016/S1353-8020(09)70004-5.

Reference Type BACKGROUND
PMID: 19131039 (View on PubMed)

Liu HG, Zhang K, Yang AC, Zhang JG. Deep brain stimulation of the subthalamic and pedunculopontine nucleus in a patient with Parkinson's disease. J Korean Neurosurg Soc. 2015 Apr;57(4):303-6. doi: 10.3340/jkns.2015.57.4.303. Epub 2015 Apr 24.

Reference Type BACKGROUND
PMID: 25932301 (View on PubMed)

Stefani A, Lozano AM, Peppe A, Stanzione P, Galati S, Tropepi D, Pierantozzi M, Brusa L, Scarnati E, Mazzone P. Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease. Brain. 2007 Jun;130(Pt 6):1596-607. doi: 10.1093/brain/awl346. Epub 2007 Jan 24.

Reference Type BACKGROUND
PMID: 17251240 (View on PubMed)

Ferraye MU, Debu B, Fraix V, Goetz L, Ardouin C, Yelnik J, Henry-Lagrange C, Seigneuret E, Piallat B, Krack P, Le Bas JF, Benabid AL, Chabardes S, Pollak P. Effects of pedunculopontine nucleus area stimulation on gait disorders in Parkinson's disease. Brain. 2010 Jan;133(Pt 1):205-14. doi: 10.1093/brain/awp229. Epub 2009 Sep 22.

Reference Type BACKGROUND
PMID: 19773356 (View on PubMed)

Giladi N, Horak FB, Hausdorff JM. Classification of gait disturbances: distinguishing between continuous and episodic changes. Mov Disord. 2013 Sep 15;28(11):1469-73. doi: 10.1002/mds.25672.

Reference Type BACKGROUND
PMID: 24132835 (View on PubMed)

Fuentes R, Petersson P, Siesser WB, Caron MG, Nicolelis MA. Spinal cord stimulation restores locomotion in animal models of Parkinson's disease. Science. 2009 Mar 20;323(5921):1578-82. doi: 10.1126/science.1164901.

Reference Type BACKGROUND
PMID: 19299613 (View on PubMed)

Fenelon G, Goujon C, Gurruchaga JM, Cesaro P, Jarraya B, Palfi S, Lefaucheur JP. Spinal cord stimulation for chronic pain improved motor function in a patient with Parkinson's disease. Parkinsonism Relat Disord. 2012 Feb;18(2):213-4. doi: 10.1016/j.parkreldis.2011.07.015. Epub 2011 Aug 23. No abstract available.

Reference Type BACKGROUND
PMID: 21865071 (View on PubMed)

Hassan S, Amer S, Alwaki A, Elborno A. A patient with Parkinson's disease benefits from spinal cord stimulation. J Clin Neurosci. 2013 Aug;20(8):1155-6. doi: 10.1016/j.jocn.2012.08.018. Epub 2013 Feb 26.

Reference Type BACKGROUND
PMID: 23453160 (View on PubMed)

Agari T, Date I. Spinal cord stimulation for the treatment of abnormal posture and gait disorder in patients with Parkinson's disease. Neurol Med Chir (Tokyo). 2012;52(7):470-4. doi: 10.2176/nmc.52.470.

Reference Type BACKGROUND
PMID: 22850494 (View on PubMed)

Landi A, Trezza A, Pirillo D, Vimercati A, Antonini A, Sganzerla EP. Spinal cord stimulation for the treatment of sensory symptoms in advanced Parkinson's disease. Neuromodulation. 2013 May-Jun;16(3):276-9. doi: 10.1111/ner.12005. Epub 2012 Dec 10. No abstract available.

Reference Type BACKGROUND
PMID: 23227965 (View on PubMed)

Yadav AP, Fuentes R, Zhang H, Vinholo T, Wang CH, Freire MA, Nicolelis MA. Chronic spinal cord electrical stimulation protects against 6-hydroxydopamine lesions. Sci Rep. 2014 Jan 23;4:3839. doi: 10.1038/srep03839.

Reference Type BACKGROUND
PMID: 24452435 (View on PubMed)

Other Identifiers

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107451

Identifier Type: -

Identifier Source: org_study_id

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