Dual Lead Thalamic Deep Brain Recording (DBR)-DBS Interface for Closed Loop Control of Severe Essential Tremor

NCT ID: NCT04212780

Last Updated: 2026-02-10

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

RECRUITING

Clinical Phase

NA

Total Enrollment

10 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-12-24

Study Completion Date

2029-12-31

Brief Summary

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This is a feasibility study based on physician-initiated Investigational Device Exemption (IDE) including intraoperative experiments and chronic testing of implanted dual thalamic DBS lead systems. This study will inform protocols for optimal use of implanted next-gen DBS systems for primarily tremor control in refractory essential tremor.If the approach appears to be successful, the pilot data generated will be used to base a future pivotal trial for FDA approval for enhanced tremor control and adaptive DBS (aDBS) functionality of DBS systems.

Detailed Description

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Ventralis intermedius nucleus of the thalamus (VIM) Deep Brain Stimulation (DBS) has emerged as a highly effective treatment for essential tremor, which is an incurable, degenerative brain disorder that results in progressively debilitating tremor, afflicting an estimated 7 million people in the US (2.2% of the population). Clinical observation shows, however, that disease progression results in eventual recurrence of debilitating tremor in 10 to 20% of VIM DBS patients. DBS revision surgery, with replacement of sub-optimally positioned VIM DBS leads and addition of an ipsilateral ventralis oralis (VO) DBS lead, has emerged as an effective rescue strategy for many such patients with delayed failure of VIM DBS therapy.

Since essential tremors are typically not continuous, tremor suppressing DBS therapy need not necessarily be delivered continuously and could theoretically be effective if delivered only when movement intent or tremor is present.

Our central hypothesis is that a VIM+VO DBS system capable of detecting the neurophysiologic markers of essential tremor (ET) associated with goal directed movements, and providing responsive dual lead thalamic stimulation in a targeted and personalized manner, would provide improved suppression of severe tremor, reduce adverse effects associated with continuous stimulation, and prolong the battery life of the implantable neurostimulator (INS), decreasing the frequency of surgical procedures necessary to replace devices with depleted batteries.

Conditions

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Essential Tremor

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DEVICE_FEASIBILITY

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Treatment Naive

Participants receiving Long-term stimulation of the thalamus via dual leads for Essential Tremor

Group Type ACTIVE_COMPARATOR

Medtronic Summit Rechargable (RC)+S

Intervention Type DEVICE

Dual channel closed-loop pulse generator with connection to both new DBS leads for deep stimulation of VIM vs VO

standard ET DBS

Intervention Type PROCEDURE

Single Lead VIM

ipsilateral VO

Intervention Type PROCEDURE

second lead in the ipsilateral VO

Refractory Participants

Patients with recurrent, debilitating intention tremor despite ongoing, optimized VIM DBS therapy

Group Type ACTIVE_COMPARATOR

Medtronic Summit Rechargable (RC)+S

Intervention Type DEVICE

Dual channel closed-loop pulse generator with connection to both new DBS leads for deep stimulation of VIM vs VO

ipsilateral thalamic (VIM+VO) DBS

Intervention Type PROCEDURE

Implantation of two new ipsilateral thalamic (VIM+VO) DBS

Interventions

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Medtronic Summit Rechargable (RC)+S

Dual channel closed-loop pulse generator with connection to both new DBS leads for deep stimulation of VIM vs VO

Intervention Type DEVICE

ipsilateral thalamic (VIM+VO) DBS

Implantation of two new ipsilateral thalamic (VIM+VO) DBS

Intervention Type PROCEDURE

standard ET DBS

Single Lead VIM

Intervention Type PROCEDURE

ipsilateral VO

second lead in the ipsilateral VO

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patient gives an informed consent.
* Patient is over 21 years of age.
* Patient is diagnosed with a postural-intention (essential) tremor for at least 3 years, meets diagnostic criteria for ET, has been evaluated and examined by a movement disorders fellowship trained neurologist, and is being treated with traditional VIM DBS therapy.
* Patient has no evidence of non-ET central nervous system disease or injury and has had a significantly disabling, upper extremity tremor despite ongoing VIM DBS therapy for at least three (3) months prior to DBS revision surgery.
* Patient has a postural or kinetic tremor severity score of at least 2 out of 4 in the extremity intended for treatment on the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (TRS) despite ongoing VIM DBS therapy.
* Patient has a TRS score of 2 or above in any one of the items 16-23 from the Disability subsection of the TRS: speaking, feeding other than liquids, bringing liquids to mouth, hygiene, dressing, writing, working and social activities despite ongoing VIM DBS therapy.
* Patient's tremor is refractory to adequate trials of at least two medications, one of which should be either propranolol or primidone. Proof of this is not required for patients with a current device that is being removed and replaced with a new device. An adequate medication trial is defined as a therapeutic dose of each medication or the development of side effects as the medication dose is titrated.
* Patient is available for appropriate follow-up times for the length of the study.

Exclusion Criteria

* Any previous neurosurgical intervention other than VIM DBS, including ablative brain lesions for tremor suppression.
* Medication related movement disorders.
* Any suspicion of Parkinson's disease, including presence of Parkinsonian features such as bradykinesia, rigidity, or postural instability.
* Any behaviors consistent with alcohol or substance abuse as defined by the criteria outlined in Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
* Severe medical co-morbidity including cardiovascular disorder, lung disorder, kidney disease, continuous neurological disease, hematological disease, or frailty that impact tolerability of the surgery as judged by the screening physicians.
* Abnormal brain MRI including hydrocephalus, stroke, structural lesions, demyelinating lesions, or infectious lesions. Also excluded will be subjects with severe brain atrophy.
* Any uncontrolled symptoms or signs of increased intracranial pressure (e.g., headache, nausea, vomiting, lethargy, papilledema).
* A history of seizures within the past year.
* A dementia rating scale score (DRS) \<130 signifying significant cognitive dysfunction and a potential for inability to cooperate with tasks involved in the study.
* Any attempt or intent of suicide during the previous six months.
* Presence or history of psychosis.
* Any person known to have abnormal coagulation or any medications which interfere with coagulation
* Significant untreated or unstable mood disorders including depression. This will be determined by the Neuropsychological team during FastTrack and by the Neurologist
* In addition, patients who are pregnant or plan to become pregnant will be excluded from this study.
Minimum Eligible Age

21 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Neurological Disorders and Stroke (NINDS)

NIH

Sponsor Role collaborator

Medtronic

INDUSTRY

Sponsor Role collaborator

University of Florida

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Karim Oweiss, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Florida

Locations

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University of Florida

Gainesville, Florida, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Cami Swartz

Role: CONTACT

352-733-2429

Karim Oweiss, PhD

Role: CONTACT

352-294-1898

Other Identifiers

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OCR29622

Identifier Type: OTHER

Identifier Source: secondary_id

1UH3NS109845-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

5UH3NS109845-02

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IRB201901021

Identifier Type: -

Identifier Source: org_study_id

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