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Focused Ultrasound Pallidotomy for Dyskinetic Cerebral Palsy in Pediatric and Young Adult Subjects

Primary Purpose

Cerebral Palsy, Dyskinetic, Secondary Dystonia

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Focused Ultrasound Pallidotomy
Sponsored by
Children's National Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cerebral Palsy, Dyskinetic focused on measuring High intensity focused ultrasound (HIFU), Pallidotomy

Eligibility Criteria

8 Years - 22 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: The treating physician has chosen GPi-DBS or pallidotomy for the treatment of the secondary dystonia caused by cerebral palsy in this patient Patient and/or legal representative, if the patient is underaged or not capable to give consent himself, have chosen pallidotomy as treatment The consent to participate in the trial of the underaged patient, if he is capable to understand the study requirements, is required Age at enrolment 8-22 years Diagnosis of secondary dystonia due to cerebral palsy caused by perinatal hypoxic injury Anti-dystonic pharmacotherapy insufficient Stable anti-dystonic medication over the last 30 days Globus pallidus internus (pars posterior) and thalamus (motor part) intact on MRI (not older than 2 years - if possible) No fixed severe skeletal deformations with loss of function, which need immediate orthopaedic surgical intervention Sufficient compliance of the patient or the legal representative if the patient is underaged or not capable to give consent himself to take part in the study Informed consent to take part in the study from patient and/or legal representative if the patient is underaged or not capable to give consent himself Patient and/or legal representative if the patient is underaged or not capable to give consent himself, understands the study requirements and the treatment procedures and provides written informed consent before any study-specific tests or procedures are performed Exclusion Criteria: Patients with known primary (e.g. DYT1) or idiopathic dystonia Severe axial hypotonia with total loss of head control (e.g. absence of control at "upper thoracic level" in the SATCo score) (medication effect excluded) Fixed hemi-dystonia Severe spasticity in knee- and elbow-flexors and -extensors (Modified Ashworth Scale >3) Fixed severe skeletal contractions with loss of function which require immediate orthopaedic surgical intervention Patients with other severe concurrent neurological disease (e. g. brain tumor, neurodegenerative diseases, trauma etc.) Condition likely to require use of MRI in the future Any intracranial abnormality or medical condition that would contraindicate DBS surgery Any findings in neuropsychological screening assessments that would contraindicate DBS surgery Any current drug and / or alcohol abuse Any history of frequent grand-mal seizures without response to anticonvulsive treatment Any other active implanted device (e.g. Cochlear implant, pacemaker), whether turned on or off, would be allowed provided that they do not interfere with functioning of the device. The presence of DBS leads due the risks of these ferromagnetic devices in the MRI environment. A history of neurostimulation intolerance in any area of the body. Currently on any anticoagulant medications that cannot be discontinued during perioperative period. Any significant medical condition that is likely to interfere with study procedures or likely to confound evaluation of study endpoints, including any terminal illness with survival <24 months. Participation in another drug, device, or biologics trial concurrently or within the preceding 30 days; any other trial participation should be approved by the Principal Investigator. A female that is breastfeeding or of childbearing potential with a positive urine pregnancy test or - if a person is sexually active - not using sufficient contraception with a Pearl Index of less than 1% including all forms of hormonal contraception ("antibaby-pill", hormonal plaster, NuvaRing®, Implanon®, hormonal depot injections, contraceptive coil), the tubal ligature (female sterilization). Alternatively, the female of child bearing potential is sexually abstinent. Subjects who have contraindications to anesthesia, in the judgment of the attending anesthesiologist Subjects who are unwilling or unable to undergo general anesthesia Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the subject or the quality of the data. Minimum head circumference < 49cm Skull Density Ratio (SDR) <0.40.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Focused Ultrasound Pallidotomy

    Arm Description

    Pediatric and young adult patients between ages of 8 and 22 years with pharmaco-resistant secondary dystonia due to dyskinetic cerebral palsy who have Focused Ultrasound Pallidotomy

    Outcomes

    Primary Outcome Measures

    Incidence and severity of device-related and procedure-related adverse events (AE)
    Safety will be determined by an evaluation of the incidence and severity of device-related and procedure-related adverse events (AE) from the first treatment day visit through the 24-month post-treatment time point. All AEs will be reported and categorized as related to the device versus the ablation procedure.

    Secondary Outcome Measures

    Burke-Fahn-Marsden-Dystonia Rating Scale movement and disability
    Assessment of speech and swallowing. Score range: 0-30, 0 indicates complete independence, 30 indicates complete dependence.
    Family Scale (FaBel)
    Assessment of the burden for caregivers. Score range: 0-84, 0 indicates no burden, 84 indicates very severe burden.
    Canadian Occupational Performance Measure (COPM)
    Assessment of activities of daily living.
    Gross Motor Function Measure (GMFM-66)
    Assessment of physical disability. Score range: 0-3, 0 indicates no performance, 3 indicates complete performance.
    Gross Motor Function Classification System (GMFCS)
    Degree of physical impairment. Score range: 1-5, 1 indicates no limitations, 5 indicates severe limitations.
    SF-36 for assessment of quality of life
    Assessment of quality of life of subject. Score range: 0-100, 0 indicates bad health state, 100 indicates an excellent health state.
    Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD)
    Assessment of Quality of life of Caregivers and Subject. Score range: 0-100, 0 indicates a bad score, 100 indicates an excellent score.
    Frenchay Dysarthria Assessment
    Assessment of speech and swallowing. Score range:
    Assessment of Cognition
    Snijders-Oomen-Non-Verbal-Intelligence Test (SON-R)
    Strengths and Difficulties Questionnaire
    Assessment of mood and attention. Score range: 0-40, 0 indicates normal, 40 indicates abnormal.
    Assessment of Attention
    Attentional Network Test (ANT)
    Assessment of cognition
    Non-Verbal-Learning Test (NVLT)
    Wong Baker Faces
    Assessment of pain. Score range; 0-10, 0 indicates no pain, 10 indicates worst pain.
    Tardieu Scale
    Assessment of the severity of spasticity. Score range: 0-5, 0 indicates no resistance, 5 indicates no movement.
    Dyskinesia Impairment Scale (DIS)
    Assessment of the severity of chorea and dystonia. Score range: 0-576, 0 indicates no dystonia, 576 indicates very severe dystonia.
    Barry Albright Dystonia Scale
    Score range: 0-32, 0 indicates no dystonia, 32 indicates severe dystonia.

    Full Information

    First Posted
    May 2, 2023
    Last Updated
    September 12, 2023
    Sponsor
    Children's National Research Institute
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    1. Study Identification

    Unique Protocol Identification Number
    NCT06036199
    Brief Title
    Focused Ultrasound Pallidotomy for Dyskinetic Cerebral Palsy in Pediatric and Young Adult Subjects
    Official Title
    Safety and Impact on Quality of Life of Focused Ultrasound Pallidotomy for Dyskinetic Cerebral Palsy in Pediatric and Young Adult Subjects
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    September 2023 (Anticipated)
    Primary Completion Date
    August 2025 (Anticipated)
    Study Completion Date
    August 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Children's National Research Institute

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    Yes
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    The primary objective of the proposed study is to evaluate the safety of ExAblate Transcranial MRgFUS as a tool for creating bilateral or unilateral lesions in the globus pallidus (GPi) in patients with treatment-refractory secondary dystonia due to dyskinetic cerebral palsy
    Detailed Description
    The primary objective of the proposed study is to evaluate the safety of ExAblate Transcranial MRgFUS as a tool for creating bilateral or unilateral lesions in the globus pallidus (GPi) in patients with treatment-refractory secondary dystonia due to dyskinetic cerebral palsy. The secondary is to assess the impact on Quality of Life of Focused Ultrasound Bilateral and unilateral Pallidotomy for Dyskinetic Cerebral Palsy in Pediatric and Young Adult Subjects. In addition, the impact of bilateral pallidotomy on motor development, pain perception, speech, memory, attention and cognition in these patients will also be assessed.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Cerebral Palsy, Dyskinetic, Secondary Dystonia
    Keywords
    High intensity focused ultrasound (HIFU), Pallidotomy

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    10 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Focused Ultrasound Pallidotomy
    Arm Type
    Experimental
    Arm Description
    Pediatric and young adult patients between ages of 8 and 22 years with pharmaco-resistant secondary dystonia due to dyskinetic cerebral palsy who have Focused Ultrasound Pallidotomy
    Intervention Type
    Device
    Intervention Name(s)
    Focused Ultrasound Pallidotomy
    Intervention Description
    Use of ExAblate Transcranial MR guided Focused Ultrasound as a tool for creating bilateral or unilateral lesions in the globus pallidus (GPi) in patients with treatment-refractory secondary dystonia due to dyskinetic cerebral palsy
    Primary Outcome Measure Information:
    Title
    Incidence and severity of device-related and procedure-related adverse events (AE)
    Description
    Safety will be determined by an evaluation of the incidence and severity of device-related and procedure-related adverse events (AE) from the first treatment day visit through the 24-month post-treatment time point. All AEs will be reported and categorized as related to the device versus the ablation procedure.
    Time Frame
    2 years
    Secondary Outcome Measure Information:
    Title
    Burke-Fahn-Marsden-Dystonia Rating Scale movement and disability
    Description
    Assessment of speech and swallowing. Score range: 0-30, 0 indicates complete independence, 30 indicates complete dependence.
    Time Frame
    2 years
    Title
    Family Scale (FaBel)
    Description
    Assessment of the burden for caregivers. Score range: 0-84, 0 indicates no burden, 84 indicates very severe burden.
    Time Frame
    2 years
    Title
    Canadian Occupational Performance Measure (COPM)
    Description
    Assessment of activities of daily living.
    Time Frame
    2 years
    Title
    Gross Motor Function Measure (GMFM-66)
    Description
    Assessment of physical disability. Score range: 0-3, 0 indicates no performance, 3 indicates complete performance.
    Time Frame
    2 years
    Title
    Gross Motor Function Classification System (GMFCS)
    Description
    Degree of physical impairment. Score range: 1-5, 1 indicates no limitations, 5 indicates severe limitations.
    Time Frame
    2 years
    Title
    SF-36 for assessment of quality of life
    Description
    Assessment of quality of life of subject. Score range: 0-100, 0 indicates bad health state, 100 indicates an excellent health state.
    Time Frame
    2 years
    Title
    Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD)
    Description
    Assessment of Quality of life of Caregivers and Subject. Score range: 0-100, 0 indicates a bad score, 100 indicates an excellent score.
    Time Frame
    2 years
    Title
    Frenchay Dysarthria Assessment
    Description
    Assessment of speech and swallowing. Score range:
    Time Frame
    2 years
    Title
    Assessment of Cognition
    Description
    Snijders-Oomen-Non-Verbal-Intelligence Test (SON-R)
    Time Frame
    2 years
    Title
    Strengths and Difficulties Questionnaire
    Description
    Assessment of mood and attention. Score range: 0-40, 0 indicates normal, 40 indicates abnormal.
    Time Frame
    2 years
    Title
    Assessment of Attention
    Description
    Attentional Network Test (ANT)
    Time Frame
    2 years
    Title
    Assessment of cognition
    Description
    Non-Verbal-Learning Test (NVLT)
    Time Frame
    2 years
    Title
    Wong Baker Faces
    Description
    Assessment of pain. Score range; 0-10, 0 indicates no pain, 10 indicates worst pain.
    Time Frame
    2 years
    Title
    Tardieu Scale
    Description
    Assessment of the severity of spasticity. Score range: 0-5, 0 indicates no resistance, 5 indicates no movement.
    Time Frame
    2 years
    Title
    Dyskinesia Impairment Scale (DIS)
    Description
    Assessment of the severity of chorea and dystonia. Score range: 0-576, 0 indicates no dystonia, 576 indicates very severe dystonia.
    Time Frame
    2 years
    Title
    Barry Albright Dystonia Scale
    Description
    Score range: 0-32, 0 indicates no dystonia, 32 indicates severe dystonia.
    Time Frame
    2 years

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    8 Years
    Maximum Age & Unit of Time
    22 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: The treating physician has chosen GPi-DBS or pallidotomy for the treatment of the secondary dystonia caused by cerebral palsy in this patient Patient and/or legal representative, if the patient is underaged or not capable to give consent himself, have chosen pallidotomy as treatment The consent to participate in the trial of the underaged patient, if he is capable to understand the study requirements, is required Age at enrolment 8-22 years Diagnosis of secondary dystonia due to cerebral palsy caused by perinatal hypoxic injury Anti-dystonic pharmacotherapy insufficient Stable anti-dystonic medication over the last 30 days Globus pallidus internus (pars posterior) and thalamus (motor part) intact on MRI (not older than 2 years - if possible) No fixed severe skeletal deformations with loss of function, which need immediate orthopaedic surgical intervention Sufficient compliance of the patient or the legal representative if the patient is underaged or not capable to give consent himself to take part in the study Informed consent to take part in the study from patient and/or legal representative if the patient is underaged or not capable to give consent himself Patient and/or legal representative if the patient is underaged or not capable to give consent himself, understands the study requirements and the treatment procedures and provides written informed consent before any study-specific tests or procedures are performed Exclusion Criteria: Patients with known primary (e.g. DYT1) or idiopathic dystonia Severe axial hypotonia with total loss of head control (e.g. absence of control at "upper thoracic level" in the SATCo score) (medication effect excluded) Fixed hemi-dystonia Severe spasticity in knee- and elbow-flexors and -extensors (Modified Ashworth Scale >3) Fixed severe skeletal contractions with loss of function which require immediate orthopaedic surgical intervention Patients with other severe concurrent neurological disease (e. g. brain tumor, neurodegenerative diseases, trauma etc.) Condition likely to require use of MRI in the future Any intracranial abnormality or medical condition that would contraindicate DBS surgery Any findings in neuropsychological screening assessments that would contraindicate DBS surgery Any current drug and / or alcohol abuse Any history of frequent grand-mal seizures without response to anticonvulsive treatment Any other active implanted device (e.g. Cochlear implant, pacemaker), whether turned on or off, would be allowed provided that they do not interfere with functioning of the device. The presence of DBS leads due the risks of these ferromagnetic devices in the MRI environment. A history of neurostimulation intolerance in any area of the body. Currently on any anticoagulant medications that cannot be discontinued during perioperative period. Any significant medical condition that is likely to interfere with study procedures or likely to confound evaluation of study endpoints, including any terminal illness with survival <24 months. Participation in another drug, device, or biologics trial concurrently or within the preceding 30 days; any other trial participation should be approved by the Principal Investigator. A female that is breastfeeding or of childbearing potential with a positive urine pregnancy test or - if a person is sexually active - not using sufficient contraception with a Pearl Index of less than 1% including all forms of hormonal contraception ("antibaby-pill", hormonal plaster, NuvaRing®, Implanon®, hormonal depot injections, contraceptive coil), the tubal ligature (female sterilization). Alternatively, the female of child bearing potential is sexually abstinent. Subjects who have contraindications to anesthesia, in the judgment of the attending anesthesiologist Subjects who are unwilling or unable to undergo general anesthesia Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the subject or the quality of the data. Minimum head circumference < 49cm Skull Density Ratio (SDR) <0.40.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Chima Oluigbo, MD
    Phone
    2024763531
    Email
    coluigbo@childrensnational.org
    First Name & Middle Initial & Last Name or Official Title & Degree
    Saige Teti
    Phone
    2024763755
    Email
    sateti@childrensnational.org
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Chima Oluigbo, MD
    Organizational Affiliation
    Children's National Hospital, Washington, DC
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Focused Ultrasound Pallidotomy for Dyskinetic Cerebral Palsy in Pediatric and Young Adult Subjects

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