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A Pilot Study of the Cala ONE Device for Essential Tremor (EXCITE)

Primary Purpose

Essential Tremor

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Cala ONE device
Sponsored by
Cala Health, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Essential Tremor

Eligibility Criteria

22 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Must be ≥22 and ≤80 years of age
  • Competent and willing to provide written, informed consent to participate in the study
  • A diagnosis of essential tremor as confirmed from clinical history and examination by a movement disorder neurologist
  • Postural, action or intention tremor severity score of 2 or above in the dominant hand/arm as measured by the CRST rating scale
  • Significant disability due to essential tremor (Bain & Findley score of 3 or above in any one of the hand items)
  • Currently or previously prescribed either propranolol or primidone for the treatment of essential tremor
  • Stable dose of tremor medications for 30 days prior to study entry
  • Stable dose of antidepressant medications for 90 days prior to study entry
  • Willing to comply with study protocol requirements including: remaining on a stable dosage of tremor and antidepressant medications, if applicable, during the duration of the study; no significant alcohol or caffeine consumption within 12 hours of study visits; and no significant alcohol or caffeine consumption within 4 hours of twice-daily at home assessments during the controlled phase of the study

Exclusion Criteria:

  • Moderate to severe ethanol dependence as defined by the criteria outlined in the DSM-5 (score of 4 or higher)
  • Implanted electrical medical device, such as a pacemaker, defibrillator, or deep brain stimulator
  • Previous thalamotomy procedure, including stereotactic thalamotomy, gamma knife radiosurgical thalamotomy, and focused ultrasound for the treatment of tremor
  • Suspected or diagnosed epilepsy or other seizure disorder
  • Swollen, infected, inflamed areas, or skin eruptions, open wounds, or cancerous lesions of skin at stimulation site
  • Peripheral neuropathy affecting the tested upper extremity
  • Presence of any other neurodegenerative disease like Parkinson-plus syndromes suspected on neurological examination. These include: multisystem atrophy, progressive supranuclear palsy, dementia with Lewy bodies, and Alzheimer's disease.
  • Anyone suspected to have the diagnosis of idiopathic Parkinson's disease (PD). This includes excluding anyone with the presence of parkinsonian features including bradykinesia rigidity, or postural instability. Subjects who exhibit only mild resting tremor but no other symptoms or signs of PD may be included.
  • Botulinum toxin injection for hand tremor within 6 months prior to study enrollment
  • Are participating or have participated in another interventional clinical trial in the last 30 days which may confound the results of this study, unless approved by the Sponsor
  • Are participating or have participated in another Cala Health clinical trial
  • Significant alcohol or caffeine consumption within 12 hours of study enrollment, which may confound the results of the study, where significant caffeine is considered more than 95 mg (equivalent to a cup of coffee), and significant alcohol is considered more than 14 g (equivalent to 5 oz of wine, 12 oz of beer, or 1.5 oz of distilled spirits).
  • Subjects unable to communicate with the investigator and staff
  • Any health condition that in the investigator's opinion should preclude participation in this study
  • Pregnancy or anticipated pregnancy during the course of the study

Sites / Locations

  • Personal Care Neurology
  • Movement & Neuroperformance Center
  • Kansas University Medical Center
  • EvergreenHealth

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Sham Comparator

No Intervention

Arm Label

TAPS

Sham

No Intervention

Arm Description

Subjects will receive a Cala ONE device that delivers TAPS, transcutaneous afferent patterned stimulation.

Subjects will receive a Cala ONE device that delivers sham stimulation.

Subjects will not receive a Cala ONE device, and will stay on their current treatment regimen for their essential tremor.

Outcomes

Primary Outcome Measures

Percent Change in Tremor Power
For TAPS and sham arms, subjects will be prompted to perform a lateral postural hold prior to entering their PGI-S score before and after each stimulation session. During this hold, the device will record motion data to objectively assess if there are any changes in tremor level.

Secondary Outcome Measures

Full Information

First Posted
May 7, 2017
Last Updated
April 8, 2019
Sponsor
Cala Health, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03152136
Brief Title
A Pilot Study of the Cala ONE Device for Essential Tremor
Acronym
EXCITE
Official Title
A Pilot Study to Evaluate the Safety and Initial Effectiveness of the Cala ONE Device to Repeatably Aid in the Symptomatic Relief of Essential Tremor
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
July 26, 2017 (Actual)
Primary Completion Date
March 8, 2018 (Actual)
Study Completion Date
March 8, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cala Health, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Prospective, multi-center, randomized, controlled study designed to evaluate safety and repeatable effectiveness. Subjects will be randomized 2:1:1 to transcutaneous afferent patterned stimulation (TAPS), sham, or 'no intervention', respectively. Subjects randomized to the TAPS and sham arms will be blinded to their randomization assignments for the first two weeks of participation (controlled phase). After the first two weeks, all subjects will be crossed over to TAPS (open-label phase) for 2 weeks. During study participation, all subjects are to remain on a stable dosage of medications prescribed for the treatment of essential tremor, if applicable.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Essential Tremor

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
The first two weeks are a 3-arm parallel design (treatment, sham, and 'no intervention'). The second two weeks are open-label (all subjects cross-over to treatment arm).
Masking
ParticipantOutcomes Assessor
Masking Description
The first two weeks of the study are double-blinded for the treatment and sham arms. The subjects and rating movement disorder neurologists will be blinded to the therapy allocation for the treatment and sham arms. The subjects in the 'no intervention' arm and their rating neurologists will not be blinded to their therapy allocation. The last two weeks are open-label, and all subjects will be given the option to use the Cala ONE device.
Allocation
Randomized
Enrollment
62 (Actual)

8. Arms, Groups, and Interventions

Arm Title
TAPS
Arm Type
Experimental
Arm Description
Subjects will receive a Cala ONE device that delivers TAPS, transcutaneous afferent patterned stimulation.
Arm Title
Sham
Arm Type
Sham Comparator
Arm Description
Subjects will receive a Cala ONE device that delivers sham stimulation.
Arm Title
No Intervention
Arm Type
No Intervention
Arm Description
Subjects will not receive a Cala ONE device, and will stay on their current treatment regimen for their essential tremor.
Intervention Type
Device
Intervention Name(s)
Cala ONE device
Intervention Description
The Cala ONE device is a wrist-worn stimulator which applies a tremor-customized stimulation pattern to an individual's nerves.
Primary Outcome Measure Information:
Title
Percent Change in Tremor Power
Description
For TAPS and sham arms, subjects will be prompted to perform a lateral postural hold prior to entering their PGI-S score before and after each stimulation session. During this hold, the device will record motion data to objectively assess if there are any changes in tremor level.
Time Frame
Mean tremor power pre stimulation over two weeks of device usage as compared to mean tremor power post stimulation over two weeks of device usage.
Other Pre-specified Outcome Measures:
Title
Change in Clinical Rating Scale for Tremor (CRST) After Stimulation
Description
A complete CRST examination (also known as the Fahn-Tolosa-Marin Tremor Rating Scale) will be completed at baseline for all arms: TAPS, sham, and 'no intervention.' For TAPS and sham arms, a subset of CRST relevant to upper limb tremor will be repeated after stimulation.
Time Frame
Collected before and after in-office stimulation sessions at Week 2
Title
Change in Clinical Global Impression of Severity (CGI-S)
Description
Tremor severity will be assessed with the 7-point CGI-S scale at baseline for all arms. For TAPS and sham arms, CGI-S will also be assessed during and after stimulation.
Time Frame
Collected before, during, and after in-office stimulation sessions at Week 0, Week 2, and Week 4
Title
Clinical Global Impression of Improvement (CGI-I)
Description
For TAPS and sham arms, the blinded rating neurologist will assess improvements in tremor level during and after stimulation.
Time Frame
Collected during and after in-office stimulation sessions at Week 0, Week 2, and Week 4
Title
Change in Bain & Findley Activities of Daily Living (ADL) Scale
Description
The complete Bain & Findley ADL questionnaire will be administered at baseline for all arms. For TAPS and sham arms, a subset of ADLs relevant to upper limb tremor will be repeated with provided props during and after stimulation. On a weekly basis, all subjects will answer the complete Bain & Findley ADL questionnaire via phone call.
Time Frame
Collected before, during, and after in-office stimulation sessions at Week 0, Week 2, and Week 4. Collected via phone call Week 1 and Week 3.
Title
Subject Impression of Durability of Effect
Description
TAPS and sham arms will also be asked how long their tremor relief lasts due to stimulation, if applicable.
Time Frame
Week 1, 2, 3 and 4.
Title
Change in Quality of Life in Essential Tremor Questionnaire (QUEST)
Description
The QUEST assessment will be administered to all subjects during in-office visits (every 2 weeks).
Time Frame
Week 0, 2, and 4
Title
Change in Patient Global Impression of Severity (PGI-S)
Description
Tremor severity will be assessed with the 7-point PGI-S scale at baseline for all arms. For TAPS and sham arms, PGI-S will also be assessed during and after stimulation during office visits. Additionally, for TAPS and sham arms, PGI-S will be entered on the device before and after each stimulation session in the home environment.
Time Frame
Before and after every stimulation session for TAPS and sham subjects through study completion. Twice daily for 'no intervention' subjects through study completion.
Title
Patient Global Impression of Improvement (PGI-I)
Description
For TAPS and sham arms, the blinded subject will assess improvements in their tremor level during and after stimulation during office visits.
Time Frame
Collected during and after in-office stimulation sessions at Week 0, Week 2, and Week 4
Title
Subject Survey of Satisfaction
Description
At the final visit, all subject will take a subject satisfaction survey which will include questions such as likelihood to recommend and other questions related to the usability of the device.
Time Frame
Week 4
Title
Device Usage Metrics
Description
For TAPS and sham arms, the device will record usage metrics such as how many times the device was used per day and stimulation amplitude, to assess if there are any changes over time within group and within subject.
Time Frame
Week 4
Title
Change in Clinical Rating Scale for Tremor (CRST) After Stimulation
Description
A complete CRST examination (also known as the Fahn-Tolosa-Marin Tremor Rating Scale) will be completed at baseline for all arms: TAPS, sham, and 'no intervention.' For TAPS and sham arms, a subset of CRST relevant to upper limb tremor will be repeated after stimulation.
Time Frame
Collected before and after in-office stimulation sessions at Week 0 and 4.
Title
Change in Clinical Rating Scale for Tremor (CRST) During Stimulation
Description
A complete CRST examination (also known as the Fahn-Tolosa-Marin Tremor Rating Scale) will be completed at baseline for all arms: TAPS, sham, and 'no intervention.' For TAPS and sham arms, a subset of CRST relevant to upper limb tremor will be repeated during stimulation.
Time Frame
Collected before and during in-office stimulation sessions at Week 0, 2 and 4.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
22 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must be ≥22 and ≤80 years of age Competent and willing to provide written, informed consent to participate in the study A diagnosis of essential tremor as confirmed from clinical history and examination by a movement disorder neurologist Postural, action or intention tremor severity score of 2 or above in the dominant hand/arm as measured by the CRST rating scale Significant disability due to essential tremor (Bain & Findley score of 3 or above in any one of the hand items) Currently or previously prescribed either propranolol or primidone for the treatment of essential tremor Stable dose of tremor medications for 30 days prior to study entry Stable dose of antidepressant medications for 90 days prior to study entry Willing to comply with study protocol requirements including: remaining on a stable dosage of tremor and antidepressant medications, if applicable, during the duration of the study; no significant alcohol or caffeine consumption within 12 hours of study visits; and no significant alcohol or caffeine consumption within 4 hours of twice-daily at home assessments during the controlled phase of the study Exclusion Criteria: Moderate to severe ethanol dependence as defined by the criteria outlined in the DSM-5 (score of 4 or higher) Implanted electrical medical device, such as a pacemaker, defibrillator, or deep brain stimulator Previous thalamotomy procedure, including stereotactic thalamotomy, gamma knife radiosurgical thalamotomy, and focused ultrasound for the treatment of tremor Suspected or diagnosed epilepsy or other seizure disorder Swollen, infected, inflamed areas, or skin eruptions, open wounds, or cancerous lesions of skin at stimulation site Peripheral neuropathy affecting the tested upper extremity Presence of any other neurodegenerative disease like Parkinson-plus syndromes suspected on neurological examination. These include: multisystem atrophy, progressive supranuclear palsy, dementia with Lewy bodies, and Alzheimer's disease. Anyone suspected to have the diagnosis of idiopathic Parkinson's disease (PD). This includes excluding anyone with the presence of parkinsonian features including bradykinesia rigidity, or postural instability. Subjects who exhibit only mild resting tremor but no other symptoms or signs of PD may be included. Botulinum toxin injection for hand tremor within 6 months prior to study enrollment Are participating or have participated in another interventional clinical trial in the last 30 days which may confound the results of this study, unless approved by the Sponsor Are participating or have participated in another Cala Health clinical trial Significant alcohol or caffeine consumption within 12 hours of study enrollment, which may confound the results of the study, where significant caffeine is considered more than 95 mg (equivalent to a cup of coffee), and significant alcohol is considered more than 14 g (equivalent to 5 oz of wine, 12 oz of beer, or 1.5 oz of distilled spirits). Subjects unable to communicate with the investigator and staff Any health condition that in the investigator's opinion should preclude participation in this study Pregnancy or anticipated pregnancy during the course of the study
Facility Information:
Facility Name
Personal Care Neurology
City
Oakland
State/Province
California
ZIP/Postal Code
94611
Country
United States
Facility Name
Movement & Neuroperformance Center
City
Denver
State/Province
Colorado
ZIP/Postal Code
80113
Country
United States
Facility Name
Kansas University Medical Center
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66103
Country
United States
Facility Name
EvergreenHealth
City
Kirkland
State/Province
Washington
ZIP/Postal Code
98034
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Data will be published, but no PHI will be made available.

Learn more about this trial

A Pilot Study of the Cala ONE Device for Essential Tremor

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