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Using Neuromodulation to Improve Parkinson's Disease

Primary Purpose

Parkinson Disease

Status
Withdrawn
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Experimental 1
Experimental 2
Sponsored by
Wake Forest University Health Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Parkinson Disease focused on measuring Parkinson Disease, Motor/Non-Motor Symptoms, Neurovascular Symptoms

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 (meeting UK PD Society Brain Bank criteria)
  • Responsive to oral DRT (dopamine replacement therapy) for a minimum of 3 years and on a stable dose of therapy
  • Must be able to voluntarily give written informed consent
  • Must have ability to reliably use the investigational device
  • Must be able to understand and complete all assessments (provided in English only) within a given on-state period
  • Must be willing and able to undertake a ~1 hour imaging session in a MRI magnet with a head coil in place during 3 separate clinic visits.
  • Must have a home partner and/or regular caregiver
  • Must have capability to complete assessments using telemedicine platforms.
  • Must demonstrate moderate burden of motor symptoms and non-motor symptoms in PD ( MDS-UPDRS part II >12 and MDS-UPDRS part I scores >10)

Exclusion Criteria:

  • Pregnant women.
  • Have experienced a heart attack, angina or stroke within the past 12 months,
  • Use of medications that regulate heart rate
  • Have a history or prior diagnosis of dementia or adjusted score ≤ 20 on the Montreal Cognitive Exam at the baseline visit.
  • Those receiving deep brain stimulation
  • Treated with a pump for continuous delivery of DRT (Dopamine replacement therapy)
  • Use of Apomorphine rescue
  • Works night shifts
  • Have a major concomitant illness or illnesses including cancer or disease of the cardiovascular, respiratory and/or renal systems
  • Has history or evidence of unstable mood disorder, or responds affirmatively to question #9 on the BDI-II (any score > 0 on suicidal thoughts or wishes). Participants that respond affirmatively to this question should receive a referral for mental health counseling according to the mandates of the IRB or ethics review committee.
  • Those with hearing aids or cochlear implants, chronic tinnitus, temporomandibular joint disease
  • Those who have persistent negative sequela of a traumatic brain injury
  • Those who have been diagnosed with another neurological illness with the exceptions of restless leg syndrome and REM behavioral sleep disorder
  • Those with a recent history of substance abuse and/or dependence (alcohol or other drugs)
  • Those who have a diagnosed vestibular dysfunction and/or balance dysfunction
  • Those who have had eye surgery within the previous three months or ear surgery within the previous six months
  • Those who have inner ear pathology, such as active and/or frequent ear infections or reported damage to the tympanic membrane or have labyrinthitis
  • Those who have contraindications for MRI imaging, such as metal implants or a pacemaker that would preclude the MRI scan
  • Those who have participated in another clinical trial within the last 30 days or are currently enrolled in another clinical trial
  • Those who are taking antiemetics chronically (more than 2 times per week, consistently) due to known interference with the vestibular response to caloric stimulation

Sites / Locations

  • Wake Forest Health Sciences

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Experimental 1

Experimental 2

Arm Description

A ThermoNeuroModulation device will be worn by the participant that delivers warm waveforms in one ear (42 °C) and cool waveforms (17 °C) in the other ear.

A ThermoNeuroModulation device will be worn by the participant that will neither warm nor cool.

Outcomes

Primary Outcome Measures

Neuroimaging
Brain data will be acquired with Siemens MAGNETOM Skyra 3T MRI - range measured by statistically significant change in cerebral blood flow (CBF) measured in units of mL/100g/min
Neuroimaging
Brain data will be acquired with Siemens MAGNETOM Skyra 3T MRI - range measured by statistically significant change in cerebral blood flow (CBF) measured in units of mL/100g/min
Neuroimaging
Brain data will be acquired with Siemens MAGNETOM Skyra 3T MRI - range measured by statistically significant change in cerebral blood flow (CBF) measured in units of mL/100g/min
Transcranial Doppler Sonography
Non-invasive ultrasound used to examine blood circulation within the brain - range measured by statistically significant change in mean cerebral blood flow velocity (cm/s)
Transcranial Doppler Sonography
Non-invasive ultrasound used to examine blood circulation within the brain - range measured by statistically significant change in mean cerebral blood flow velocity (cm/s)

Secondary Outcome Measures

MDS-Unified Parkinson's Disease Rating Scale
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
Timed Up and Go Test
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).
Montreal Cognitive Assessment
Cognitive screening test - range from zero to 30, with a score of 26 and higher generally considered normal.
Non-Motor Symptom Scale
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 NMSS measures the severity and frequency of non-motor symptoms across nine dimensions - the total NMSQuest 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.
Geriatric Depression Scale
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.
Parkinson's Anxiety Scale
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.
Epworth Sleepiness Scale
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'.
Functional Assessment of Chronic Illness Therapy - Fatigue -
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

Full Information

First Posted
July 23, 2020
Last Updated
October 12, 2020
Sponsor
Wake Forest University Health Sciences
Collaborators
Michael J. Fox Foundation for Parkinson's Research
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1. Study Identification

Unique Protocol Identification Number
NCT04493697
Brief Title
Using Neuromodulation to Improve 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 2020
Overall Recruitment Status
Withdrawn
Why Stopped
Device provider has requested withdrawal citing modifications needed for study integrity.
Study Start Date
September 2020 (Anticipated)
Primary Completion Date
September 2021 (Anticipated)
Study Completion Date
September 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Wake Forest University Health Sciences
Collaborators
Michael J. Fox Foundation for Parkinson's Research

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.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is a single-site, double-blinded, placebo-controlled, randomized clinical trial designed to elucidate mechanism(s) of action for symptomatic benefits observed in Parkinson's disease (PD) patients treating twice daily time-varying caloric vestibular stimulation treatment using a solid-state 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 will be compared to changes in validated standardized clinical measures of motor and non-motor symptoms in PD. The durability of effects will be evaluated at a post-treatment assessment conducted five weeks after treatment cessation.
Detailed Description
A double-blinded, placebo-controlled randomized trial will explore the effects of time-varying caloric vestibular stimulation (tvCVS) treatments on changes in biomarkers of neurovascular status (i.e. cerebral blood flow perfusion and cerebrovascular reactivity) as well as their relationship to clinical endpoints. Participants will be randomly allocated in a 1:1 ratio using block randomization by the clinical site. Participants will be trained in the clinic to self-administer device treatment and then will continue to self-administer the ~19-minute treatments twice daily for 12 weeks in the home. Individual stimulation sessions will be spaced a minimum of 1 hour apart. Outcome measures will be administered at the baseline, the end of the 12-week treatment period and at 5 weeks post-treatment. Study participants will continue to take their approved Parkinson's disease (PD) medications throughout the study and will maintain patterns of usage throughout. Previous evidence for efficacy demonstrated therapeutic gains as an adjuvant for standard of care treatment. Consistent with these observations, all outcome measures will be evaluated when study participants are in the on-medication state and at the same time relative to the last dose of anti-Parkinsonian medication across all assessments. Clinical measures will be captured at the baseline, at the end of treatment period, and again five weeks after cessation of treatment. Most of the planned clinical measures including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts I, II, and IV, the Non-Motor Symptom Scale for PD (NMSS), the Montreal Cognitive Assessment (MoCA), the Parkinson's Anxiety Scale, the Geriatric Depression Scale, the Epworth Sleepiness Scale, and the Functional Assessment of Chronic Illness Therapy- Fatigue are suitable for virtual collection. Case report forms (CRFs) for the patient reported outcomes will be provided to study participants via standard mail. At the end of each virtual visit, participants will be asked to complete these forms and bring them to the clinic the next day when they come for their in-clinic visit. In the case where an in-clinic visit may not be possible, participants will be asked to show completed forms to the coordinator via the telemedicine platform to confirm completeness, and forms will be collected at the next in-person visit or can be mailed in by the participant. The full MDS- UPDRS part III and the Timed Up and Go will be administered in the clinic. However, a modified MDS-UPDRS part III (excluding items related to rigidity or postural instability) will also be administered through the telemedicine platform. This measure will serve as backup for cases where participants may be unable to come into the clinic for regularly scheduled assessment (e.g. due to COVID-19 containment measures).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson Disease
Keywords
Parkinson Disease, Motor/Non-Motor Symptoms, Neurovascular Symptoms

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
All participants will receive a ThermoNeuroModulation device for in-home use. Participants will be randomized to either the active or placebo treatment arm.
Masking
ParticipantCare ProviderInvestigator
Masking Description
The device uses a bar code reader to import a prescription waveform. The use of the bar code aids blinding during randomization since the QR code is not readable by study members.
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Experimental 1
Arm Type
Active Comparator
Arm Description
A ThermoNeuroModulation device will be worn by the participant that delivers warm waveforms in one ear (42 °C) and cool waveforms (17 °C) in the other ear.
Arm Title
Experimental 2
Arm Type
Placebo Comparator
Arm Description
A ThermoNeuroModulation device will be worn by the participant that will neither warm nor cool.
Intervention Type
Device
Intervention Name(s)
Experimental 1
Intervention Description
A ThermoNeuroModulation device will be worn by the participant that delivers warm waveforms in one ear (42 °C) and cool waveforms (17 °C) in the other ear.
Intervention Type
Device
Intervention Name(s)
Experimental 2
Intervention Description
A ThermoNeuroModulation device will be worn by the participant that will neither warm nor cool.
Primary Outcome Measure Information:
Title
Neuroimaging
Description
Brain data will be acquired with Siemens MAGNETOM Skyra 3T MRI - range measured by statistically significant change in cerebral blood flow (CBF) measured in units of mL/100g/min
Time Frame
Baseline
Title
Neuroimaging
Description
Brain data will be acquired with Siemens MAGNETOM Skyra 3T MRI - range measured by statistically significant change in cerebral blood flow (CBF) measured in units of mL/100g/min
Time Frame
Week 12
Title
Neuroimaging
Description
Brain data will be acquired with Siemens MAGNETOM Skyra 3T MRI - range measured by statistically significant change in cerebral blood flow (CBF) measured in units of mL/100g/min
Time Frame
Week 17
Title
Transcranial Doppler Sonography
Description
Non-invasive ultrasound used to examine blood circulation within the brain - range measured by statistically significant change in mean cerebral blood flow velocity (cm/s)
Time Frame
Baseline
Title
Transcranial Doppler Sonography
Description
Non-invasive ultrasound used to examine blood circulation within the brain - range measured by statistically significant change in mean cerebral blood flow velocity (cm/s)
Time Frame
Week 12
Secondary Outcome Measure Information:
Title
MDS-Unified Parkinson's Disease Rating Scale
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, Week 12, Week 17
Title
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, Week 12, Week 17
Title
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, Week 12, Week 17
Title
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 NMSS measures the severity and frequency of non-motor symptoms across nine dimensions - the total NMSQuest 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.
Time Frame
Baseline, Week 12, Week 17
Title
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, Week 12, Week 17
Title
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, Week 12, Week 17
Title
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, Week 12, Week 17
Title
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, Week 12, Week 17

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 (meeting UK PD Society Brain Bank criteria) Responsive to oral DRT (dopamine replacement therapy) for a minimum of 3 years and on a stable dose of therapy Must be able to voluntarily give written informed consent Must have ability to reliably use the investigational device Must be able to understand and complete all assessments (provided in English only) within a given on-state period Must be willing and able to undertake a ~1 hour imaging session in a MRI magnet with a head coil in place during 3 separate clinic visits. Must have a home partner and/or regular caregiver Must have capability to complete assessments using telemedicine platforms. Must demonstrate moderate burden of motor symptoms and non-motor symptoms in PD ( MDS-UPDRS part II >12 and MDS-UPDRS part I scores >10) Exclusion Criteria: Pregnant women. Have experienced a heart attack, angina or stroke within the past 12 months, Use of medications that regulate heart rate Have a history or prior diagnosis of dementia or adjusted score ≤ 20 on the Montreal Cognitive Exam at the baseline visit. Those receiving deep brain stimulation Treated with a pump for continuous delivery of DRT (Dopamine replacement therapy) Use of Apomorphine rescue Works night shifts Have a major concomitant illness or illnesses including cancer or disease of the cardiovascular, respiratory and/or renal systems Has history or evidence of unstable mood disorder, or responds affirmatively to question #9 on the BDI-II (any score > 0 on suicidal thoughts or wishes). Participants that respond affirmatively to this question should receive a referral for mental health counseling according to the mandates of the IRB or ethics review committee. Those with hearing aids or cochlear implants, chronic tinnitus, temporomandibular joint disease Those who have persistent negative sequela of a traumatic brain injury Those who have been diagnosed with another neurological illness with the exceptions of restless leg syndrome and REM behavioral sleep disorder Those with a recent history of substance abuse and/or dependence (alcohol or other drugs) Those who have a diagnosed vestibular dysfunction and/or balance dysfunction Those who have had eye surgery within the previous three months or ear surgery within the previous six months Those who have inner ear pathology, such as active and/or frequent ear infections or reported damage to the tympanic membrane or have labyrinthitis Those who have contraindications for MRI imaging, such as metal implants or a pacemaker that would preclude the MRI scan Those who have participated in another clinical trial within the last 30 days or are currently enrolled in another clinical trial Those who are taking antiemetics chronically (more than 2 times per week, consistently) due to known interference with the vestibular response to caloric stimulation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christopher T Whitlow, MD
Organizational Affiliation
Wake Forest 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

12. IPD Sharing Statement

Plan to Share IPD
No

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Using Neuromodulation to Improve Parkinson's Disease

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