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Use of a Non-Invasive Brainstem Neuromodulation Device to Improve Neurovascular Status in Parkinson's Disease

Primary Purpose

Parkinson Disease

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Non-invasive brainstem stimulation
Sponsored by
Wake Forest University Health Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Parkinson Disease focused on measuring balance disorders, motor functions

Eligibility Criteria

21 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Must be 21-85 years old
  • Diagnosed with Parkinson's Disease
  • Within driving distance of Atrium Health Wake Forest Baptist (Winston-Salem, NC)
  • Responsive to Parkinson's medication for a minimum of 3 years
  • Have ability to reliably use the investigational device
  • Understand and complete all assessments (provided in English only)
  • Be able to have 3 separate MRI scans (1.5 hours per MRI)
  • Have a study partner/regular caregiver that is willing to participate in the trial
  • Demonstrate moderate burden of motor symptoms and non-motor symptoms
  • Consent to being videotaped during motor examination visit
  • Willing to answer questions related to sexual interest, arousal and performance in an interview with study staff

Exclusion Criteria:

  • Cannot attend all study visits (4 on-site visits) or complete all study activities
  • Heart attack, angina, or stroke within the past year
  • Use medications that regulate heart rate
  • Have a history or prior diagnosis of dementia
  • Receiving deep brain stimulation therapy
  • Treated with a pump for continuous delivery of dopamine replacement therapy
  • Use of Apomorphine rescue
  • Works night shifts
  • Have any significant co-morbidity such as stroke, brain tumor, epilepsy, Alzheimer's disease, multiple sclerosis, ALS, atypical Parkinsonism, or aneurysm
  • History or evidence of unstable mood disorder or demonstrates evidence of suicidality
  • Hearing aids that are implanted or cannot be easily removed and replaced, such as cochlear implants
  • Chronic ringing in the ears for more than 3 months
  • Diagnosed with traumatic brain injury with ongoing symptoms
  • Recent history of substance abuse and/or dependence (alcohol or other drugs)
  • Diagnosed balance dysfunction
  • Eye surgery within the previous 3 months
  • Ear surgery within the previous 6 months
  • Active ear infection, perforated tympanic membrane, or inner ear inflammation
  • Recent history of frequent ear infections (≥ 1 per year over the past two years)
  • Contraindications for MRI scans, such as metal implants or a pacemaker
  • Currently enrolled or have participated in another interventional clinical trial within the last 30 days
  • Taking medication for vomiting or nausea more than 2 times per week, consistently
  • Ongoing symptoms from a COVID-19 infection that includes one or more of the exclusion criteria listed above
  • Planned surgery scheduled to occur during the clinical trial that requires sedation and/or would typically be followed with a prescription for pain management
  • Women who are pregnant or plan to become pregnant during the the study

Women of child-bearing potential (i.e., are not yet 3 years removed from their first menopausal symptom), who are not abstinent or exclusively in same sex relationships must:

Test negative for pregnancy as indicated by a negative urine pregnancy test

Agree to use an approved contraception method

Sites / Locations

  • Wake Forest Health SciencesRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Treatment 1

Treatment 2

Arm Description

Participants will receive Experimental treatment 1 stimulation for a duration of 12 weeks, twice daily for 19 minutes

Participants will receive Experimental treatment 2 stimulation for a duration of 12 weeks, twice daily for 19 minutes

Outcomes

Primary Outcome Measures

Change in cerebral blood flow (CBF) perfusion
Arterial arrival time (AAT) measured using pseudo Continuous Arterial Spin Labeling (pCASL) magnetic resonance imaging (MRI) will be used to monitor changes in global perfusion.
Change in cerebral blood flow (CBF) perfusion
Arterial arrival time (AAT) measured using pseudo Continuous Arterial Spin Labeling (pCASL) magnetic resonance imaging (MRI) will be used to monitor changes in global perfusion.
Change in cerebrovascular Reactivity
AAT measured using pCASL MRI after a hypercapnic challenge will be used to monitor changes in cerebrovascular reactivity
Change in cerebrovascular Reactivity
AAT measured using pCASL MRI after a hypercapnic challenge will be used to monitor changes in cerebrovascular reactivity

Secondary Outcome Measures

Change in functional connectivity
Resting-state magnetic resonance imaging (rs-MRI) will be used to monitor changes in functional connectivity

Full Information

First Posted
October 16, 2020
Last Updated
July 26, 2023
Sponsor
Wake Forest University Health Sciences
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1. Study Identification

Unique Protocol Identification Number
NCT04598828
Brief Title
Use of a Non-Invasive Brainstem Neuromodulation Device to Improve Neurovascular Status in Parkinson's Disease
Official Title
Using Time Varying Non-Invasive Neuromodulation to Improve Neurovascular Status in Parkinson's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 6, 2021 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
June 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Wake Forest University Health Sciences

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is a single-site, double-blinded, randomized clinical trial designed to elucidate mechanism(s) of action for symptomatic benefits observed in Parkinson's disease (PD)
Detailed Description
Patients treating twice daily using a non-invasive brainstem modulation device. Study participants will self-administer treatments in the home setting over a period of 12 weeks. Changes in cerebral blood flow perfusion, cerebrovascular reactivity and functional connectivity between the pre-treatment baseline and the end of the treatment period will be monitored and compared to changes in validated standardized clinical measures of motor and non-motor symptoms in PD.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson Disease
Keywords
balance disorders, motor functions

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment 1
Arm Type
Experimental
Arm Description
Participants will receive Experimental treatment 1 stimulation for a duration of 12 weeks, twice daily for 19 minutes
Arm Title
Treatment 2
Arm Type
Experimental
Arm Description
Participants will receive Experimental treatment 2 stimulation for a duration of 12 weeks, twice daily for 19 minutes
Intervention Type
Device
Intervention Name(s)
Non-invasive brainstem stimulation
Intervention Description
Study participants will self-administer ~19-minute treatments twice daily in the home setting using a non-invasive brainstem modulation device. The device has been deemed as a nonsignificant risk for studies in Parkinson's disease by the United States Food and Drug Administration.
Primary Outcome Measure Information:
Title
Change in cerebral blood flow (CBF) perfusion
Description
Arterial arrival time (AAT) measured using pseudo Continuous Arterial Spin Labeling (pCASL) magnetic resonance imaging (MRI) will be used to monitor changes in global perfusion.
Time Frame
baseline
Title
Change in cerebral blood flow (CBF) perfusion
Description
Arterial arrival time (AAT) measured using pseudo Continuous Arterial Spin Labeling (pCASL) magnetic resonance imaging (MRI) will be used to monitor changes in global perfusion.
Time Frame
end of treatment (week 12)
Title
Change in cerebrovascular Reactivity
Description
AAT measured using pCASL MRI after a hypercapnic challenge will be used to monitor changes in cerebrovascular reactivity
Time Frame
baseline
Title
Change in cerebrovascular Reactivity
Description
AAT measured using pCASL MRI after a hypercapnic challenge will be used to monitor changes in cerebrovascular reactivity
Time Frame
end of treatment (week 12)
Secondary Outcome Measure Information:
Title
Change in functional connectivity
Description
Resting-state magnetic resonance imaging (rs-MRI) will be used to monitor changes in functional connectivity
Time Frame
baseline and end of treatment (week 12)
Other Pre-specified Outcome Measures:
Title
Change in cerebral haemodynamics
Description
Transcranial Doppler sonography (TCD), a non-invasive ultrasound, will be used to monitor changes in cerebral blood flow velocity (cm/s) in response to a hypercapnic challenge.
Time Frame
baseline and end of treatment (week 12)
Title
Durability of change of cerebral blood flow (CBF) perfusion
Description
Arterial arrival time (AAT) measured using pseudo Continuous Arterial Spin Labeling (pCASL) magnetic resonance imaging (MRI) will be used to monitor changes in global perfusion.
Time Frame
baseline and the post-treatment follow-up (week 17)
Title
Durability of change of cerebrovascular Reactivity
Description
AAT measured using pCASL MRI after a hypercapnic challenge will be used to monitor changes in cerebrovascular reactivity
Time Frame
baseline and the post-treatment follow-up (week 17)
Title
Durability of change of functional connectivity
Description
Resting-state magnetic resonance imaging (rs-MRI) will be used to monitor changes in functional connectivity
Time Frame
baseline and the post-treatment follow-up (week 17)
Title
Change in the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS)
Description
Used to follow the longitudinal course of symptoms of Parkinson's disease - Each parkinsonian sign or symptom is rated on a 5-point Likert-type scale (ranging from 0 to 4), with higher scores indicating more severe impairment. The maximum total UPDRS score is 199, indicating the worst possible disability from PD
Time Frame
baseline, end of treatment (week 12), and the post-treatment follow-up (week 17)
Title
Change in the Timed Up and Go Test
Description
To determine fall risk and measure the progress of balance, sit to stand and walking (ranging from ≤10 seconds as normal to 30 seconds as high fall risk).
Time Frame
baseline, end of treatment (week 12) and the post-treatment follow-up (week 17)
Title
Change in the Montreal Cognitive Assessment
Description
Cognitive screening test - range from zero to 30, with a score of 26 and higher generally considered normal.
Time Frame
baseline, end of treatment (week 12) and the post-treatment follow-up (week 17)
Title
Change in the Non-Motor Symptom Scale
Description
Scale to assess a wide range of non-motor symptoms in patients with Parkinson's disease - 30-item rater-based scale to assess a wide range of non-motor symptoms in patients with Parkinson's disease (PD). The Non-Motor Symptom Scale measures the severity and frequency of non-motor symptoms across nine dimensions - the total score significantly increased with disease severity and duration meaning that the number of individual non-motor symptoms reported by our patients increases as the disease progresses. Score range 0 - 360.
Time Frame
Change between the baseline and end of treatment (week 12) measure.
Title
Change in the Non-Motor Symptom Scale
Description
Scale to assess a wide range of non-motor symptoms in patients with Parkinson's disease - 30-item rater-based scale to assess a wide range of non-motor symptoms in patients with Parkinson's disease (PD). The Non-Motor Symptom Scale measures the severity and frequency of non-motor symptoms across nine dimensions - the total score significantly increased with disease severity and duration meaning that the number of individual non-motor symptoms reported by our patients increases as the disease progresses. Score range 0 - 360.
Time Frame
Change between the baseline and the post-treatment follow-up (week 17) measure.
Title
Change in the Geriatric Depression Scale
Description
A self-report measure of depression in older adults - Scores of 0-4 are considered normal, depending on age, education, and complaints; 5-8 indicate mild depression; 9-11 indicate moderate depression; and 12-15 indicate severe depression.
Time Frame
baseline, end of treatment (week 12) and the post-treatment follow-up (week 17)
Title
Change in the Parkinson's Anxiety Scale
Description
Anxiety assessment - The PAS is a 12-item observer or patient-rated scale with three subscales, for persistent, episodic anxiety and avoidance behavior - There is a maximum total score of 48. Higher scores indicate great experiences of anxiety.
Time Frame
baseline, end of treatment (week 12) and the post-treatment follow-up (week 17)
Title
Change in the Epworth Sleepiness Scale
Description
A self-administered questionnaire to assess the daytime sleepiness - The ESS score (the sum of 8 item scores, 0-3) can range from 0 to 24. The higher the ESS score, the higher that person's average sleep propensity in daily life (ASP), or their 'daytime sleepiness'.
Time Frame
baseline, end of treatment (week 12) and the post-treatment follow-up (week 17)
Title
Change in the Functional Assessment of Chronic Illness Therapy - Fatigue
Description
A tool to help manage chronic illness - The responses to the 13 items on the FACIT fatigue questionnaire are each measured on a 4-point Likert scale. Thus, the total score ranges from 0 to 52. High scores represent less fatigue
Time Frame
baseline, end of treatment (week 12) and the post-treatment follow-up (week 17)
Title
Change in Arterial Stiffness
Description
Arterial stiffness will be assessed as carotid-femoral pulse wave velocity (PWV). PWV is calculated by dividing the distance between the carotid and femoral arteries by the pulse transit time.
Time Frame
baseline and end of treatment (week 12)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must be 21-85 years old Diagnosed with Parkinson's Disease Within driving distance of Atrium Health Wake Forest Baptist (Winston-Salem, NC) Responsive to Parkinson's medication for a minimum of 3 years Have ability to reliably use the investigational device Understand and complete all assessments (provided in English only) Be able to have 3 separate MRI scans (1.5 hours per MRI) Have a study partner/regular caregiver that is willing to participate in the trial Demonstrate moderate burden of motor symptoms and non-motor symptoms Consent to being videotaped during motor examination visit Willing to answer questions related to sexual interest, arousal and performance in an interview with study staff Exclusion Criteria: Cannot attend all study visits (4 on-site visits) or complete all study activities Heart attack, angina, or stroke within the past year Use medications that regulate heart rate Have a history or prior diagnosis of dementia Receiving deep brain stimulation therapy Treated with a pump for continuous delivery of dopamine replacement therapy Use of Apomorphine rescue Works night shifts Have any significant co-morbidity such as stroke, brain tumor, epilepsy, Alzheimer's disease, multiple sclerosis, ALS, atypical Parkinsonism, or aneurysm History or evidence of unstable mood disorder or demonstrates evidence of suicidality Hearing aids that are implanted or cannot be easily removed and replaced, such as cochlear implants Chronic ringing in the ears for more than 3 months Diagnosed with traumatic brain injury with ongoing symptoms Recent history of substance abuse and/or dependence (alcohol or other drugs) Diagnosed balance dysfunction Eye surgery within the previous 3 months Ear surgery within the previous 6 months Active ear infection, perforated tympanic membrane, or inner ear inflammation Recent history of frequent ear infections (≥ 1 per year over the past two years) Contraindications for MRI scans, such as metal implants or a pacemaker Currently enrolled or have participated in another interventional clinical trial within the last 30 days Taking medication for vomiting or nausea more than 2 times per week, consistently Ongoing symptoms from a COVID-19 infection that includes one or more of the exclusion criteria listed above Planned surgery scheduled to occur during the clinical trial that requires sedation and/or would typically be followed with a prescription for pain management Women who are pregnant or plan to become pregnant during the the study Women of child-bearing potential (i.e., are not yet 3 years removed from their first menopausal symptom), who are not abstinent or exclusively in same sex relationships must: Test negative for pregnancy as indicated by a negative urine pregnancy test Agree to use an approved contraception method
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Christopher T Whitlow, MD, PhD
Phone
336-713-8793
Email
cwhitlow@wakehealth.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Richarlette C Hightower, BA
Phone
336-713-8793
Email
rhightow@wakehealth.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christopher T Whitlow, MD, PhD
Organizational Affiliation
Wake Forest University Health Sciences
Official's Role
Principal Investigator
Facility Information:
Facility Name
Wake Forest Health Sciences
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Richarlette C Hightower
Email
rhightow@wakehealth.edu
First Name & Middle Initial & Last Name & Degree
Christopher T Whitlow, MD, PhD, MHA
First Name & Middle Initial & Last Name & Degree
Christoper T Whitlow, MD, PhD, MHA

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Individual participant data (IPD) will not be available to other researchers.

Learn more about this trial

Use of a Non-Invasive Brainstem Neuromodulation Device to Improve Neurovascular Status in Parkinson's Disease

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