Neural Control of Breathing in Parkinson's Disease

NCT ID: NCT06074614

Last Updated: 2024-12-20

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

Total Enrollment

30 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-10-30

Study Completion Date

2025-05-31

Brief Summary

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Breathing is a complex process, which can be controlled through voluntary command or neural control. Parkinson's disease (PD) is a progressive neurological disorder. Many individuals with PD experience respiratory problems, such as coughing difficulties or shortness of breath. Changes in neural control of breathing could be part of the reason of these respiratory problems. This study will measure whether neural control of breathing is impaired in individuals with PD compared to healthy individuals.

Detailed Description

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Rationale: Parkinson's disease (PD) is a progressive neurological disorder, characterised by loss of dopaminergic neurons. Respiratory dysfunction is common in patients with PD and can lead to pneumonia, which is a common cause of death in PD. However, the exact mechanism of respiratory dysfunction in PD is unknown. The complex process of neural control of breathing may be involved, but this is understudied. This is partly caused by methodological limitations to quantify neural control of breathing. In this study, we will use respiratory neurophysiological methods to determine whether neural control of breathing is impaired in Parkinson's disease. These techniques are hypercapnic ventilatory response, respiratory related evoked potentials and transcranial magnetic stimulation. This study will test the hypothesis that the neural control of breathing is impaired in individuals with PD compared to healthy subjects.

Objective: Primary Objective: To identify disease (Parkinson's disease) specific alterations in neural control of breathing by using respiratory neurophysiological techniques.

Study design: Exploratory cross-sectional study.

Study population: Healthy subjects (n=15) and patients with Parkinson's disease (n=15) \>18 years old.

Main study parameters/endpoints:

* Hypercapnic ventilatory response curve (HCVR): HCVR will be determined using the CO2-rebreathing technique.
* Respiratory related evoked potential (RREP): RREP is a measure of cerebral cortical activity elicited by a short inspiratory occlusion.
* Transcranial magnetic stimulation (TMS) diaphragm: TMS is an established tool for investigating the cortical excitability related to breathing.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The risk of this study for the participants is negligible. Subjects do not directly benefit from participating in this study. The scientific benefit of this study is to achieve a better understanding of the neural control of breathing in Parkinson's disease. The outcomes of this study may give rise to future new treatments in Parkinson's disease. The burden of the separate study procedures is relatively small: there are no invasive procedures and patients continue their medication as usual. However, the total time of the visit and the collective burden of the experiments may be perceived as strenuous. Therefore, subjects will be explicitly informed about this aspect of the study, and enough breaks will be scheduled in the program.

Conditions

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Parkinson Disease

Keywords

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Parkinson's disease Respiratory dysfunction Neural control of breathing Transcranial magnetic stimulation Hypercapnic ventilatory response Respiratory related evoked potential

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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Parkison's disease

Participants with clinically confirmed Parkinson's disease, Hoehn and Yahr stage 1 to 3.

Hypercapnic ventilatory response

Intervention Type DIAGNOSTIC_TEST

Control of breathing is predominantly regulated by feedback of the central chemoreceptors. All chemoreceptors are sensitive to changes in partial pressure of carbon dioxide and via acid-base reactions to hydrogen concentration. The hypercapnic ventilatory response test shows the relationship between end-tidal PCO2 and the resulting minute ventilation.

Respiratory related evoked potential

Intervention Type DIAGNOSTIC_TEST

The RREP is a measure of cerebral cortical activity elicited by short inspiratory occlusion or breathing against inspiratory resistive loads and quantifies the initial arrival and further processing of sensory afferent respiratory information in the cortex.

Transcranial magnetic stimulation

Intervention Type DIAGNOSTIC_TEST

Transcranial magnetic stimulation of the diaphragm is an established tool for investigating the cortical excitability related to breathing. TMS will be delivered over the vertex using a magnetic stimulator and a 110mm double cone coil.

Healthy controls

Participants without Parkinson's disease.

Hypercapnic ventilatory response

Intervention Type DIAGNOSTIC_TEST

Control of breathing is predominantly regulated by feedback of the central chemoreceptors. All chemoreceptors are sensitive to changes in partial pressure of carbon dioxide and via acid-base reactions to hydrogen concentration. The hypercapnic ventilatory response test shows the relationship between end-tidal PCO2 and the resulting minute ventilation.

Respiratory related evoked potential

Intervention Type DIAGNOSTIC_TEST

The RREP is a measure of cerebral cortical activity elicited by short inspiratory occlusion or breathing against inspiratory resistive loads and quantifies the initial arrival and further processing of sensory afferent respiratory information in the cortex.

Transcranial magnetic stimulation

Intervention Type DIAGNOSTIC_TEST

Transcranial magnetic stimulation of the diaphragm is an established tool for investigating the cortical excitability related to breathing. TMS will be delivered over the vertex using a magnetic stimulator and a 110mm double cone coil.

Interventions

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Hypercapnic ventilatory response

Control of breathing is predominantly regulated by feedback of the central chemoreceptors. All chemoreceptors are sensitive to changes in partial pressure of carbon dioxide and via acid-base reactions to hydrogen concentration. The hypercapnic ventilatory response test shows the relationship between end-tidal PCO2 and the resulting minute ventilation.

Intervention Type DIAGNOSTIC_TEST

Respiratory related evoked potential

The RREP is a measure of cerebral cortical activity elicited by short inspiratory occlusion or breathing against inspiratory resistive loads and quantifies the initial arrival and further processing of sensory afferent respiratory information in the cortex.

Intervention Type DIAGNOSTIC_TEST

Transcranial magnetic stimulation

Transcranial magnetic stimulation of the diaphragm is an established tool for investigating the cortical excitability related to breathing. TMS will be delivered over the vertex using a magnetic stimulator and a 110mm double cone coil.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Healthy subjects: competent adult (\>18 years) volunteers
* Patients: adult (\<18 years) patients with Parkinson's disease, clinically confirmed by a movement disorder specialised neurologist with Hoehn and Yahr staging 1 to 3
* Willingness and ability to understand nature and content of the study
* Ability to participate and comply with study requirements

Exclusion Criteria

* Healthy subjects: previous or ongoing diseases of the central nervous system
* Patients: previous or ongoing diseases of the central nervous system, other than Parkinson's disease
* History of or current psychiatric treatment
* History of or current brain surgery or epilepsy, unclusing deep brain stimulation
* Neuromuscular disorders
* Pre-existing pulmonary disease, such as chronic obstructive pulmonary disease, asthma or pulmonary fibrosis
* TMS incompatibility (metal parts in head or neck, skin allergies)
* Implanted cardiac pacemaker or defibrillator, neurostimulator, cochlear implant or medical infusion device
* Large or ferromagnetic metal parts in the head (exept for a dental wire)
* Pregnancy
* Smoking
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Radboud University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jonne Doorduin, PhD

Role: PRINCIPAL_INVESTIGATOR

Radboud University Medical Center

Locations

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Radboudumc

Nijmegen, Gelderland, Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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Jonne Doorduin, PhD

Role: CONTACT

Phone: +31243611111

Email: [email protected]

Facility Contacts

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Jonne Doorduin, PhD

Role: primary

Other Identifiers

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NL84745.091.23

Identifier Type: -

Identifier Source: org_study_id