Exploring the Effects of Spinal Cord Stimulation in Parkinson's Disease.
NCT ID: NCT03526991
Last Updated: 2024-03-15
Study Results
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Basic Information
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RECRUITING
NA
10 participants
INTERVENTIONAL
2021-08-01
2025-06-30
Brief Summary
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The purpose of this study is to evaluate the effectiveness of spinal cord stimulation (SCS) for the management of freezing of gait (FOG) that does not respond to conventional treatments in subjects with Parkinson's disease (PD). The investigators hypothesize that SCS significantly decreases FOG episodes in patients with PD.
1. Assess the safety, tolerability and preliminary evidence of effectiveness of upper thoracic spinal cord stimulation for freezing of gait in Parkinson's (PD) patients.
2. Explore the effects of two SCS programming paradigms on motor, nonmotor and quality of life measures in PD patients with freezing of gait.
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Detailed Description
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FOG leads to reduced mobility, loss of independence, social embarrassment, and caregiver stress. While most motor features of PD respond robustly to dopaminergic agents and deep brain stimulation (DBS), there are currently no effective treatments for FOG.
Indirect evidence from case reports of PD patients undergoing spinal cord stimulation (SCS) for neuropathic pain, has consistently described a positive effect of SCS on FOG. In addition, two recent reports demonstrated that thoracic SCS improved locomotion and FOG in patients with advanced PD. The promising role of SCS for the treatment of FOG in PD has encouraged us to assemble a multi-disciplinary team for the systematic investigation of the motor effects of SCS on FOG, locomotion and other parkinsonian features.
The current study integrates minimally invasive SCS and the use of robotic technology to determine objective gait parameters. The investigators propose a pilot study for the implantation of SCS to the spinal cord on PD patients with treatment-refractory FOG, including a longitudinal assessment of motor outcomes. Motors assessments will include: PAMSys and LEGSys to characterize gait, ActivePERS motion sensor to monitor ambulation parameters and overall activity at home, participants will also be given electronic tablets for the ActivePERS to collect real time information about falls.
Conditions
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Study Design
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RANDOMIZED
CROSSOVER
DEVICE_FEASIBILITY
SINGLE
Study Groups
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Spinal Cord Stimulation (SCS) Tonic stimulation
Tonic stimulation
Spinal Cord Stimulator (SCS)
The SCS implantation technique consists of inserting epidural leads-containing multiple stimulating electrodes (8). Two leads will be implanted percutaneously into the epidural space.
The implantable pulse generator (IPG) is a neurostimulation system designed to deliver low-intensity electrical impulses. The system is intended to be used with leads and extensions that are compatible with the system. This neurostimulation system is indicated (FDA approved) as an aid in the management of chronic, intractable pain of the trunk and/or limbs. The intended use in this study is considered experimental.
Spinal Cord Stimulation (SCS) Burst stimulation
Burst stimulation.
Spinal Cord Stimulator (SCS)
The SCS implantation technique consists of inserting epidural leads-containing multiple stimulating electrodes (8). Two leads will be implanted percutaneously into the epidural space.
The implantable pulse generator (IPG) is a neurostimulation system designed to deliver low-intensity electrical impulses. The system is intended to be used with leads and extensions that are compatible with the system. This neurostimulation system is indicated (FDA approved) as an aid in the management of chronic, intractable pain of the trunk and/or limbs. The intended use in this study is considered experimental.
Interventions
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Spinal Cord Stimulator (SCS)
The SCS implantation technique consists of inserting epidural leads-containing multiple stimulating electrodes (8). Two leads will be implanted percutaneously into the epidural space.
The implantable pulse generator (IPG) is a neurostimulation system designed to deliver low-intensity electrical impulses. The system is intended to be used with leads and extensions that are compatible with the system. This neurostimulation system is indicated (FDA approved) as an aid in the management of chronic, intractable pain of the trunk and/or limbs. The intended use in this study is considered experimental.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Able to provide informed consent
* Diagnosed with idiopathic PD (meeting at least two of the three United Kingdom (UK) Brain Bank criteria for PD, specifically bradykinesia plus resting tremor or rigidity) whose major complaints is levodopa refractory FOG. Levodopa refractoriness will be defined as lack of subjective improvement on FOG episodes as reported by the patient.
* Documented dopaminergic response
* Optimized PD treatment including dopaminergic medications, and/or deep brain stimulation (DBS) therapy
* Presence of at least two self-reported levodopa refractory episodes of FOG per day, not limited to start hesitation
* At least one witnessed freezing event during the screening visit in the 'on' medication state (defined as 45 minutes after a regular dose of Levodopa for the subject being studied)
Exclusion Criteria
* Presence of psychosis
* Depression BDI \>14
* Anxiety BAI \>14
* Presence of an active infection, uncontrolled diabetes mellitus, immunosuppression or other medical contraindications to undergoing SCS implantation
* Patients who are currently on anticoagulation treatment or unable to hold off the anticoagulants (including Plavix, Aspirin, Warfarin, etc.) 7 days prior to the SCS procedure.
* Moderate Cognitive Impairment defined by a MoCA \< 23
* Diagnosis of failed back surgery syndrome, Complex Regional Pain Syndrome (CRPS) or intractable low back pain and leg pain.
* Women of childbearing potential will be excluded as from participation due to the limited safety data of thoracic SCS on the fetus.
18 Years
ALL
No
Sponsors
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Nora Vanegas
OTHER
Responsible Party
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Nora Vanegas
Associate Professor of Neurology
Principal Investigators
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Nora Vanegas, MD
Role: PRINCIPAL_INVESTIGATOR
Baylor College of Medicine
Locations
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Columbia University
New York, New York, United States
Baylor College of Medicine
Houston, Texas, United States
Countries
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Central Contacts
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Facility Contacts
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References
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Other Identifiers
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H-49023
Identifier Type: -
Identifier Source: org_study_id
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