search
Back to results

Investigating the Use of Complex Pulse Shapes for DBS in Movement Disorders (INSHAPE_DBS)

Primary Purpose

Parkinson Disease, Essential Tremor

Status
Completed
Phase
Not Applicable
Locations
Belgium
Study Type
Interventional
Intervention
Boston Scientific: Study tool computer
Sponsored by
KU Leuven
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Parkinson Disease

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria for PD:

  • Diagnosis of idiopathic Parkinson's disease where the diagnosis was made by a Movement Disorder Specialist according to the MDS criteria of 2015, with a Hoehn and Yahr scale (H&Y) of at least 2 (bilateral involvement).
  • Onset of the symptoms more than five years ago.
  • MDS-UPDRS-III score of ≥30 without medication or DBS.
  • Electrodes are implanted in target area STN.

Inclusion Criteria for ET:

  • Patient is diagnosed with essential tremor by a Movement Disorder Specialist.
  • Diagnosis since more than 3 years.
  • Patient has a disabling medical-refractory upper extremity tremor without medication or DBS.
  • Patient has a postural or kinetic tremor severity score of at least 3 out of 4 in the extremity intended for treatment on the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor without medication or DBS.
  • Electrodes are implanted in target area VIM.

General Inclusion Criteria:

  • Post-op the implanted electrodes pass an integrity check, i.e. no open or shorted electrodes.
  • Stable medications
  • Lack of dementia or depression.
  • Patient is willing and able to comply with all visits and study related procedures
  • Patient understands the study requirements and the treatment procedures and provides written informed consent before any study-specific tests or procedures are performed.
  • Patient can tolerate at least 12 hours OFF medication and per clinical judgement be able to perform all study related procedures

Exclusion Criteria:

  • Any significant psychiatric problems, including unrelated clinically significant depression.
  • Any current drug or alcohol abuse.
  • Any history of recurrent or unprovoked seizures.
  • Have 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 <12 months.

Sites / Locations

  • KU Leuven

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Standard clinical pulse shape

Complex pulse shape

Arm Description

Standard clinical pulse shape as used in clinical practice (cathodic stimulation).

Complex pulse shape (i.e. biphasic pulse shape anode first, biphasic pulse shape cathode first, hyperpolarizing pre-pulse or depolarizing pre-pulse)

Outcomes

Primary Outcome Measures

Stage 1: Therapeutic window = Amplitude at which therapeutic benefit is obtained versus amplitude at which side-effects occur, both expressed in mA (milliamperes).
Amplitude at which therapeutic benefit is obtained versus amplitude at which side-effects occur, both expressed in mA (milliamperes).
Stage 2 ET (3 hours): tremor scores
FTM (Fahn-Tolosa-Marin) total score. Max 116 (higher score for more tremor).
Stage 2 ET (3 hours): ataxia scores
ICARS (International cooperative ataxia rating scale): total score. Max 100 (higher score for more ataxia).
Stage 2 ET (1 week): number of treatment-related adverse events as assessed by CTCAE v4.0
Follow-up of (S)AE related to the study during that week
Stage 2 PD (1 week): number of treatment-related adverse events as assessed by CTCAE v4.0
Follow-up of (S)AE related to the study during that week
Stage 3 ET (2 years): number of treatment-related adverse events as assessed by CTCAE v4.0
Follow-up of (S)AE related to the study during those 2 years

Secondary Outcome Measures

Stage 1: Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Follow-up of (S)AE related to the study upto 1 week after the experiment
Stage 2 ET (3 hours): Therapeutic window: Amplitude to elicit tremor arrest, amplitude to elicit ataxia, amplitude to elicit stim-induced side-effects
Amplitude to elicit tremor arrest, amplitude to elicit ataxia, amplitude to elicit stimulation-induced side-effects (all expressed in mA)
Stage 2 ET (3 hours): tremor subscores
FTM (Fahn-Tolosa-Marin) subscores: items 5, 6, 11, 12 and 13 (max 48, higher score for more tremor)
Stage 2 ET (3 hours): ataxia subscores
ICARS (international cooperative ataxia rating scale): item 10 (max 8, higher score for more ataxia)
Stage 2 ET (3 hours): speech assessment (least dysarthria)
Tests: sustained phonation /a/, diadochokinesis /tatata/, text reading and spontaneous speech Outcome: which of both pulses has less dysarthria per test (either cathodic pulse, either experimental pulse)
Stage 2 ET (1 week): tremor scores and subscores
FTM (Fahn-Tolosa-Marin) tremor rating scale: total score (max 116, higher score for more tremor) subscores: items 5, 6, 11, 12 and 13 (max 48, higher score for more tremor)
Stage 2 ET (1 week): ataxia subscores and total score
ICARS (international cooperative ataxia rating scale): total score: max 100, higher score for more ataxia subscore: item 10 (max 8, higher score for more ataxia)
Stage 2 ET (1 week): tremor measured with Kinesia One wearable
Amount of postural tremor and kinetic tremor in both hands (max 4 per side, higher score for more tremor)
Stage 2 ET (1 week): tremor time measured with Kinesia 360
Amount of tremor time measured with Kinesia 360 wearable (%, higher score for more tremor time)
Stage 2 ET (1 week): speech assessment (least dysarthria)
Tests: sustained phonation /a/, diadochokinesis /tatata/, text reading and spontaneous speech Outcome: which of both pulses has less dysarthria per test (either cathodic pulse, either experimental pulse)
Stage 2 ET (1 week): cognition
MoCA (Montreal Cognitive Assessment). Max 30, higher score for better cognition.
Stage 2 ET (1 week): quality-of-life
QUEST (Quality-of-life in essential tremor questionnaire). Max 100%, higher score for worse quality-of-life.
Stage 2 ET (1 week): quality-of-life
VAS (visual analogue scale) for: amount of tremor discomfort due to tremor Max 10, higher scores for worse outcome.
Stage 2 PD (1 week): therapeutic window (amplitude at loss of rigidity and amplitude at stim-induced side-effects)
Amplitude at loss of rigidity and amplitude at stimulation-induced side-effects
Stage 2 PD (1 week): assessment motor symptoms in Parkinson's
MDS-UPDRS-III (Movement Disorders Society Unified Parkinson's Disease Rating Scale, part III). Max 132, higher score for more parkinsonian symptoms.
Stage 2 PD (1 week): assessment non-motor symptoms in Parkinson's
NMSS (non-motor symptoms scale). Max 30, higher scores for more symptoms.
Stage 2 PD (1 week): assessment of motor symptoms in Parkinson's with Kinesia One wearable
Wearable scores finger tapping and hand opening. Max 4 per item, higher scores for more symptoms.
Stage 2 PD (1 week): assessment motor symptoms in Parkinson's with Kinesia 360 wearable
Wearable score amount of time that patient was bradykinetic and dyskinetic. Expressed as %, higher scores for more symptoms
Stage 2 PD (1 week): assessment of speech (least dysarthria)
Tests: sustained phonation /a/, diadochokinesis /tatata/, text reading and spontaneous speech Outcome: which of both pulses has less dysarthria per test (either cathodic pulse, either experimental pulse)
Stage 2 PD (1 week): cognition
MoCA (Montreal Cognitive Assessment). Max 30, higher score for better cognition.
Stage 2 PD (1 week): quality-of-life
PDQ-39 (Parkinson's disease Questionnaire): 39-item questionnaire on quality-of-life. Expressed in %, higher score for more symptoms.
Stage 2 PD (1 week): quality-of-life
VAS (visual analogue scale) for: amount of parkinsonian symptoms discomfort due to parkinsonian symptoms Max 10, higher scores for worse outcome.

Full Information

First Posted
November 24, 2020
Last Updated
April 28, 2022
Sponsor
KU Leuven
search

1. Study Identification

Unique Protocol Identification Number
NCT04725045
Brief Title
Investigating the Use of Complex Pulse Shapes for DBS in Movement Disorders
Acronym
INSHAPE_DBS
Official Title
Investigating the Use of Complex Pulse Shapes for DBS in Movement Disorders
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Completed
Study Start Date
February 12, 2019 (Actual)
Primary Completion Date
April 14, 2022 (Actual)
Study Completion Date
April 14, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
KU Leuven

4. Oversight

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

5. Study Description

Brief Summary
Parkinson's disease and essential tremor are chronic movement disorders for which there is no cure. When medication is no longer effective, deep brain stimulation (DBS) is recommended. Standard DBS is a neuromodulation method that uses a simple monophasic pulse, delivered from an electrode to stimulate neurons in a target brain area. This monophasic pulse spreads out from the electrode creating a broad, electric field that stimulates a large neural population. This can often effectively reduce motor symptoms. However, many DBS patients experience side effects - caused by stimulation of non-target neurons - and suboptimal symptom control - caused by inadequate stimulation of the correct neural target. The ability to carefully manipulate the stimulating electric field to target specific neural subpopulations could solve these problems and improve patient outcomes. The use of complex pulse shapes, specifically biphasic pulses and asymmetric pre-pulses, can control the temporal properties of the stimulation field. Evidence suggests that temporal manipulations of the stimulation field can exploit biophysical differences in neurons to target specific subpopulations. Therefore, our aim is to evaluate the effectiveness of complex pulse shapes to reduce side effects and improve symptom control in DBS movement patients.
Detailed Description
The study had three stages. In the first stage, a wide range of investigatory pulse shapes in a small number of patients. The effect of the pulses on the therapeutic window will be assessed. Stage 2 will perform a short-term chronic evaluation in a larger number of patients of the complex pulse shape selected as most interesting from stage 1. ET patients will first be assessed after 3 hours of the cathodic or complex pulse (double-blind design). PD patients will only be assessed after 1 week of each pulse. Stage 3 will then focus on long-term evaluation (upto 2 years). Outcomes: see stage 2.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
Randomized, crossover, double-blinded design
Masking
ParticipantOutcomes Assessor
Masking Description
Double-blinded design
Allocation
Randomized
Enrollment
28 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Standard clinical pulse shape
Arm Type
Active Comparator
Arm Description
Standard clinical pulse shape as used in clinical practice (cathodic stimulation).
Arm Title
Complex pulse shape
Arm Type
Experimental
Arm Description
Complex pulse shape (i.e. biphasic pulse shape anode first, biphasic pulse shape cathode first, hyperpolarizing pre-pulse or depolarizing pre-pulse)
Intervention Type
Device
Intervention Name(s)
Boston Scientific: Study tool computer
Intervention Description
compare clinical outcome measurements of complex pulse shapes to standard clinical pulse shape
Primary Outcome Measure Information:
Title
Stage 1: Therapeutic window = Amplitude at which therapeutic benefit is obtained versus amplitude at which side-effects occur, both expressed in mA (milliamperes).
Description
Amplitude at which therapeutic benefit is obtained versus amplitude at which side-effects occur, both expressed in mA (milliamperes).
Time Frame
Immediately after testing
Title
Stage 2 ET (3 hours): tremor scores
Description
FTM (Fahn-Tolosa-Marin) total score. Max 116 (higher score for more tremor).
Time Frame
Measured after 3 hours of stimulation
Title
Stage 2 ET (3 hours): ataxia scores
Description
ICARS (International cooperative ataxia rating scale): total score. Max 100 (higher score for more ataxia).
Time Frame
Measured after 3 hours of stimulation
Title
Stage 2 ET (1 week): number of treatment-related adverse events as assessed by CTCAE v4.0
Description
Follow-up of (S)AE related to the study during that week
Time Frame
During 1 week of stimulation
Title
Stage 2 PD (1 week): number of treatment-related adverse events as assessed by CTCAE v4.0
Description
Follow-up of (S)AE related to the study during that week
Time Frame
During 1 week of stimulation
Title
Stage 3 ET (2 years): number of treatment-related adverse events as assessed by CTCAE v4.0
Description
Follow-up of (S)AE related to the study during those 2 years
Time Frame
During 2 years of stimulation
Secondary Outcome Measure Information:
Title
Stage 1: Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Description
Follow-up of (S)AE related to the study upto 1 week after the experiment
Time Frame
Upto one week after the study visit of stage 1
Title
Stage 2 ET (3 hours): Therapeutic window: Amplitude to elicit tremor arrest, amplitude to elicit ataxia, amplitude to elicit stim-induced side-effects
Description
Amplitude to elicit tremor arrest, amplitude to elicit ataxia, amplitude to elicit stimulation-induced side-effects (all expressed in mA)
Time Frame
Immediately after testing
Title
Stage 2 ET (3 hours): tremor subscores
Description
FTM (Fahn-Tolosa-Marin) subscores: items 5, 6, 11, 12 and 13 (max 48, higher score for more tremor)
Time Frame
Measured at 1 hours, 2 hours and 3 hours after start of stimulation
Title
Stage 2 ET (3 hours): ataxia subscores
Description
ICARS (international cooperative ataxia rating scale): item 10 (max 8, higher score for more ataxia)
Time Frame
Measured at 1 hours, 2 hours and 3 hours after start of stimulation
Title
Stage 2 ET (3 hours): speech assessment (least dysarthria)
Description
Tests: sustained phonation /a/, diadochokinesis /tatata/, text reading and spontaneous speech Outcome: which of both pulses has less dysarthria per test (either cathodic pulse, either experimental pulse)
Time Frame
Measured at 1 hours, 2 hours and 3 hours after start of stimulation
Title
Stage 2 ET (1 week): tremor scores and subscores
Description
FTM (Fahn-Tolosa-Marin) tremor rating scale: total score (max 116, higher score for more tremor) subscores: items 5, 6, 11, 12 and 13 (max 48, higher score for more tremor)
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 ET (1 week): ataxia subscores and total score
Description
ICARS (international cooperative ataxia rating scale): total score: max 100, higher score for more ataxia subscore: item 10 (max 8, higher score for more ataxia)
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 ET (1 week): tremor measured with Kinesia One wearable
Description
Amount of postural tremor and kinetic tremor in both hands (max 4 per side, higher score for more tremor)
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 ET (1 week): tremor time measured with Kinesia 360
Description
Amount of tremor time measured with Kinesia 360 wearable (%, higher score for more tremor time)
Time Frame
Measured during 1 week of stimulation
Title
Stage 2 ET (1 week): speech assessment (least dysarthria)
Description
Tests: sustained phonation /a/, diadochokinesis /tatata/, text reading and spontaneous speech Outcome: which of both pulses has less dysarthria per test (either cathodic pulse, either experimental pulse)
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 ET (1 week): cognition
Description
MoCA (Montreal Cognitive Assessment). Max 30, higher score for better cognition.
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 ET (1 week): quality-of-life
Description
QUEST (Quality-of-life in essential tremor questionnaire). Max 100%, higher score for worse quality-of-life.
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 ET (1 week): quality-of-life
Description
VAS (visual analogue scale) for: amount of tremor discomfort due to tremor Max 10, higher scores for worse outcome.
Time Frame
Measured once daily during 1 week of stimulation
Title
Stage 2 PD (1 week): therapeutic window (amplitude at loss of rigidity and amplitude at stim-induced side-effects)
Description
Amplitude at loss of rigidity and amplitude at stimulation-induced side-effects
Time Frame
Immediately after testing
Title
Stage 2 PD (1 week): assessment motor symptoms in Parkinson's
Description
MDS-UPDRS-III (Movement Disorders Society Unified Parkinson's Disease Rating Scale, part III). Max 132, higher score for more parkinsonian symptoms.
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 PD (1 week): assessment non-motor symptoms in Parkinson's
Description
NMSS (non-motor symptoms scale). Max 30, higher scores for more symptoms.
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 PD (1 week): assessment of motor symptoms in Parkinson's with Kinesia One wearable
Description
Wearable scores finger tapping and hand opening. Max 4 per item, higher scores for more symptoms.
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 PD (1 week): assessment motor symptoms in Parkinson's with Kinesia 360 wearable
Description
Wearable score amount of time that patient was bradykinetic and dyskinetic. Expressed as %, higher scores for more symptoms
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 PD (1 week): assessment of speech (least dysarthria)
Description
Tests: sustained phonation /a/, diadochokinesis /tatata/, text reading and spontaneous speech Outcome: which of both pulses has less dysarthria per test (either cathodic pulse, either experimental pulse)
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 PD (1 week): cognition
Description
MoCA (Montreal Cognitive Assessment). Max 30, higher score for better cognition.
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 PD (1 week): quality-of-life
Description
PDQ-39 (Parkinson's disease Questionnaire): 39-item questionnaire on quality-of-life. Expressed in %, higher score for more symptoms.
Time Frame
Measured after 1 week of stimulation
Title
Stage 2 PD (1 week): quality-of-life
Description
VAS (visual analogue scale) for: amount of parkinsonian symptoms discomfort due to parkinsonian symptoms Max 10, higher scores for worse outcome.
Time Frame
Measured once daily during 1 week of stimulation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria for PD: Diagnosis of idiopathic Parkinson's disease where the diagnosis was made by a Movement Disorder Specialist according to the MDS criteria of 2015, with a Hoehn and Yahr scale (H&Y) of at least 2 (bilateral involvement). Onset of the symptoms more than five years ago. MDS-UPDRS-III score of ≥30 without medication or DBS. Electrodes are implanted in target area STN. Inclusion Criteria for ET: Patient is diagnosed with essential tremor by a Movement Disorder Specialist. Diagnosis since more than 3 years. Patient has a disabling medical-refractory upper extremity tremor without medication or DBS. Patient has a postural or kinetic tremor severity score of at least 3 out of 4 in the extremity intended for treatment on the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor without medication or DBS. Electrodes are implanted in target area VIM. General Inclusion Criteria: Post-op the implanted electrodes pass an integrity check, i.e. no open or shorted electrodes. Stable medications Lack of dementia or depression. Patient is willing and able to comply with all visits and study related procedures Patient understands the study requirements and the treatment procedures and provides written informed consent before any study-specific tests or procedures are performed. Patient can tolerate at least 12 hours OFF medication and per clinical judgement be able to perform all study related procedures Exclusion Criteria: Any significant psychiatric problems, including unrelated clinically significant depression. Any current drug or alcohol abuse. Any history of recurrent or unprovoked seizures. Have 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 <12 months.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Myles Mc Laughlin, Prof. Dr.
Organizational Affiliation
KU Leuven
Official's Role
Principal Investigator
Facility Information:
Facility Name
KU Leuven
City
Leuven
ZIP/Postal Code
3000
Country
Belgium

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Investigating the Use of Complex Pulse Shapes for DBS in Movement Disorders

We'll reach out to this number within 24 hrs