Neural and Kinematic Features of Freezing of Gait for Adaptive Neurostimulation

NCT ID: NCT03180515

Last Updated: 2019-11-21

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 12 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-05-15
• Study Completion Date: 2018-10-31

Brief Summary

Continuous deep brain stimulation (cDBS) is an established therapy for the major motor signs in Parkinson's disease, however some patients find that it does not adequately treat their freezing of gait (FOG). Currently, cDBS is limited to "open-loop" stimulation,without real-time adjustment to the patient's state of activity, fluctuations and types of motor symptoms, medication dosages, or neural markers of the disease. The purpose of this study is to determine if an adaptive DBS system,responding to patient specific, clinically relevant neural or kinematic feedback related to FOG, is more effective than continuous DBS on the motor Unified Parkinson's Disease Rating Scale (UPDRS III) and gait measures of PD.

Conditions

Parkinson Disease

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: NONE

Study Groups

Activa PC+S Neurostimulator

All patients will complete motor testing on both continuous DBS and adaptive DBS during a study visit. The UPDRS rater and the patient will be blind to which type of stimulation they are on.

Group Type: EXPERIMENTAL

Activa PC+S Neurostimulator

Intervention Type: DEVICE

Activa PC+S Neurostimulator is approved for both aDBS and cDBS paradigms.

Interventions

Activa PC+S Neurostimulator

Activa PC+S Neurostimulator is approved for both aDBS and cDBS paradigms.

Intervention Type: DEVICE

Other Intervention Names

adaptive deep brain stimulation (aDBS); continuous deep brain stimulation (cDBS)

Eligibility Criteria

Inclusion Criteria

1. A diagnosis of idiopathic Parkinson's disease, with bilateral symptoms at Hoehn and Yahr Stage greater than or equal to II.

2. Documented improvement in motor signs on versus off dopaminergic medication, with a change in the Unified Parkinson's Disease Rating Scale motor (UPDRS III) score of >= 30% off to on medication.

3. The presence of complications of medication such as wearing off signs,fluctuating responses and/or dyskinesias, and/or medication refractory tremor,and/or impairment in the quality of life on or off medication due to these factors.

4. Subjects should be on stable doses of medications, which should remain unchanged until the DBS system is activated. After the DBS system is optimized(during which time the overall medication dose may be reduced to avoid discomfort and complications such as dyskinesias) the medication dose should remain unchanged, if possible, for the duration of the study.

5. Treatment with carbidopa/levodopa, and with a dopamine agonist at the maximal tolerated doses as determined by a movement disorders neurologist.

6. Ability and willingness to return for study visits, at the initial programming and after three, six and twelve months of DBS.

7. Age > 18

8. Has a history of and/or displays freezing of gait

Exclusion Criteria

1. Subjects with significant cognitive impairment and/or dementia as determined bya standardized neuropsychological battery.

2. Subjects with clinically active depression, defined according to the Diagnostic and Statistical manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and as scored on a validated depression assessment scale.

3. Subjects with very advanced Parkinson's disease, Hoehn and Yahr stage 5 on medication (non-ambulatory).

4. Age > 80.

5. Subjects with an implanted electronic device such as a neurostimulator, cardiac pacemaker/defibrillator or medication pump.

6. Subjects, who are pregnant, are capable of becoming pregnant, or who are breast feeding.

7. Patients with cortical atrophy out of proportion to age or focal brain lesions that could indicate a non-idiopathic movement disorder as determined by MRI

8. Subjects having a major comorbidity increasing the risk of surgery (prior stroke,severe hypertension, severe diabetes, or need for chronic anti-coagulation other than aspirin).

9. Subjects having any prior intracranial surgery.

10. Subjects with a history of seizures.

11. Subjects, who are immunocompromised.

12. Subjects with an active infection.

13. Subjects, who require diathermy, electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS) to treat a chronic condition.

14. Subjects, who have an inability to comply with study follow-up visits or study protocol.

15. Subjects, who are unable to understand or sign the informed consent.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Stanford University

OTHER

Sponsor Role: lead

Responsible Party

Helen M. Bronte-Stewart

John E. Cahill Family Profressor, Professor of Neurology and, by courtesy, Neurosurgery at the Stanford University Medical Center

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Helen Bronte-Stewart, MS, MD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

Stanford Movement Disorders

Palo Alto, California, United States

Countries

United States

Provided Documents

Document Type: Statistical Analysis Plan

View Document

Document Type: Study Protocol

View Document

Other Identifiers

1R21NS096398

Identifier Type: NIH

Identifier Source: org_study_id

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