Cereset Research For Chronic Nausea
This study will explore the use of Cereset Research for symptoms associated with refractory chronic nausea in patients with gastroparesis (GP) in a randomized, clinical trial.
|Condition or Disease||Intervention/Treatment||Phase|
Cereset Research (CR) is a noninvasive, close-loop, acoustic stimulation brain feedback system. CR translates brainwaves in real time, echoing them immediately via earbuds. This supports the brain to auto calibrate, self adjust, and relax (acoustic neuromodulation). The brain wave patterns are observed to shift towards improved balance and reduced hyperarousal, getting unstuck from what have become stuck patterns related to trauma and stress. Previous clinical trials using CR, as well as the legacy technology HIRREM, have shown significant benefit to reduce symptoms (stress, anxiety, depression, insomnia, Post-traumatic stress disorder (PTSD), persistent post-concussion symptoms, hot flashes, and others). Improved autonomic nervous system function has also been documented) heart rate variability and variable reflex sensitivity), as well as improved network connectivity on functional Magnetic resonance imaging (MRI) before and after the intervention.
Gastroparesis with normal gastric emptying, and associated chronic nausea, is a challenging clinical condition. There is associated autonomic dysfunction, along with many behavioral symptoms, and effective treatments are lacking. Based on prior studies, there is a reason to believe that CR may have beneficial effects for such patients. This controlled clinical trial will enroll up to 24 adults, age 18 or older, who have symptoms of chronic nausea (due to gastroparesis and who are not taking medications or supplements for management of symptoms) with a goal of 20 to complete the intervention. Participants will be randomly assigned to either an Early Intervention (EI) group which will receive 6 CR sessions over 4 weeks of audible tones echoing current brainwave activity, following enrollment, or a Delayed Intervention (DI) group which will continue current care only and will serve as a control group. Participants in both groups will continue their other current care throughout the study.
Arms and Interventions
|Active Comparator: Cereset Research
Intervention arm using 6 CR sessions
Device: Cereset Research
Device: Cereset Research The upgraded platform for medical research using the HIRREM technology has been rebranded as Cereset Research® (CR). This system uses the same core technology and algorithms to echo brainwaves in real-time using audible tones, as with HIRREM. The CR system also includes 64-bit processing architecture for faster feedback, the use of 4 sensors, and the use of standard protocols (with flexibility regarding the length and sequencing of the standard protocols), all done with eyes closed. Four sensors are applied to the scalp at a time. However, only two sensors are actively echoing feedback. The software automatically switches from one sensor pair to the other when needed. This reduces the number of sensor placement changes needed, resulting in shorter session time and fewer interruptions.
|No Intervention: Continued Current Care
Participants will continue their current care.
Primary Outcome Measures
- Change in Gastroparesis Cardinal Symptom Index (GCSI) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The Gastroparesis Cardinal Symptom Index (GCSI) is a 9-item scale within the Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM).episodes). The severity of symptom response scale ranges from 0 ("none"), 1 ("mild"), 2 ("moderate"), 3 ("severe") to 4 ("very severe"). Score can range from 0 to 4. High scores reflect greater symptom severity.
- Change in Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGY-SYM) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM) is 20 items. This inventory includes six subscales of related GI distress including heartburn/regurgitation, fullness/early satiety, nausea/vomiting, bloating, upper abdominal pain, and lower abdominal pain. Individual item scores range from 0 (none) to 5 (very severe). The higher the score, the more severe the GI symptoms.
Secondary Outcome Measures
- Change in Nausea Profile (NP) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The Nausea Profile evaluates the experience of 3 dimensions which are involved in the complex feeling of nausea; somatic distress, Gastrointestinal (GI) distress, and emotional distress. The degree to which the patient felt/feels each of the following descriptors during the nauseous period is rated by the patient on a scale of 0 (not at all) to 9 (severely). Higher scores suggest more nausea.
- Change in Center for Epidemiologic Studies Depression Scale (CES-D) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The Center for Epidemiologic Studies Depression Scale (CES-D) is a depression scale, which will help to assess this co-morbidity. CES-D is a 20-item survey assessing affective depressive symptomatology to screen for risk of depression. Scores range from 0-60, with a score of 16 commonly used as a clinically relevant cut-off. The higher the score, the more suggestive of depressive symptoms.
- Change in Generalized Anxiety Disorder-7 (GAD-7) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The Generalized Anxiety Disorder-7 (GAD-7) is a seven-item screening tool for anxiety that is widely used in primary care. GAD-7 is a brief, reliable and valid measure of assessing generalized anxiety disorder. A score of 10 or greater on the GAD-7 represents a reasonable cut point for identifying cases. Cut points of 5, 10, and 15 might be interpreted as representing mild, moderate, and severe levels of anxiety.
Other Outcome Measures
- Change in Severity of Insomnia (ISI) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The ISI is a 7 question, self-reported measure to evaluate symptoms of insomnia, with responses from 0-4 for each question, yielding scores ranging from 0-28. Lower scores represent better outcomes.
- Change in Post-traumatic stress disorder (PTSD) Checklist for civilians (PCL-C) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The PTSD Checklist for civilians (PCL-C), measures the American Psychiatric Association's Diagnostic and statistical manual of mental disorders (DSM-IV) Criteria B, C, & D of PTSD symptoms based on traumatic life experience either in civilian life. Seventeen items are rated on a Likert scale with a composite score range of 17 to 85. A score of 44 or higher correlates with probability of civilian-related PTSD. Higher scores suggest more traumatic stress.
- Change in Perceived Stress Scale (PSS) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The Perceived Stress Scale (PSS) is a ten-item psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in one's life are appraised as stressful. Items were designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale, with answers rated from 0-4, also includes a number of direct queries about current levels of experienced stress. Total scores range from 0-40. A lower score denotes a lower level of perceived stress.
- Change in Fatigue Severity Scale (FSS) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
Fatigue Severity Scale (FSS) is a nine-item instrument to assess how fatigue interferes with daily activities. Items are scored on a 7-point scale ranging from 1=strongly disagree to 7=strongly agree. Total scores range from 9 to 63 and the higher the rating demonstrates greater fatigue severity.
- Change in Patient Assessment of Upper Gastrointestinal Disorders - Quality of Life (PAGI-QOl) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QOL) is a specific scale for how Gastrointestinal (GI) symptoms impact quality of life in those with GI disorders. The scale consists of 30-items scored from 0 (none of the time) to 5 (all of the time) with a recall period of the last 2-weeks. Lower scores suggest better outcomes.
- Changes in European Quality of Life Five Dimension (EQ-5D) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The self-rating health question from the EQ-5D on a scale of 0-100 (0 = worst imaginable health state, 100 = best imaginable health state) will be administered to get a snapshot of overall health at that point in time.
- Change in The Interpersonal Support Evaluation List (ISEL-12) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The Interpersonal Support Evaluation List - Shortened Version (ISEL-12) is a 12-item scale that was modified from a 40-item scale used to assess perceptions of social support. Three dimensions are evaluated: appraisal support, belonging support, and tangible support. Each item is scaled from 1 to 4 for "Definitely True" to "Definitely False." Total scores range from 0-36 and higher scores suggest more social support.
- Change in Short Form McGill Pain Questionnaire (MPQ) scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
Short Form McGill Pain Questionnaire (MPQ) will be given to those who also report chronic pain. The MPQ is made up of 78 words and scores range from 0 (no pain) to 78 (severe pain).
- Change in the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form Pain Interference questionnaire scores [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The PROMIS Short Form Pain Interference questionnaire will be given too those who report chronic pain. The PROMIS short form is a 6-point Likert-type scale, with scores ranging from 1 (had no pain) to 6 (always) over a 7-day recall period. Higher scores suggest more pain interference
- Change in Heart Rate Variability (HRV) [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
Measures of heart rate variability in frequency domain will be derived and measures integrated over specified frequency ranges.
- Change in Heart Rate (HR) [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
Continuous heart rate will be recorded while participant is breathing normally in seated position for 10 minutes using Faros 180 heart rate monitor (Bittium Corporation, Oulu, Finland). Beat to beat intervals (RRI) files will be generated at 1000 Hz via the data acquisition software. Files will be analyzed with Nevrokard HRV software (by Nevrokard Kiauta, d.o.o., Izola, Slovenia). Recordings will be visually inspected to ensure data quality (dropped beats or gross motion artifacts are excluded) and first 5 minutes of usable tracings will be analyzed.
- Change in Baroreflex Sensitivity (BRS) [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
BRS calculated by this method is based on quantification of sequences of at least three beats (n) in which SBP consecutively increases (UP sequence) or decreases (DOWN sequence), which are accompanied by changes in the same direction of the RRI of subsequent beats (n+1). The software scans the RRI and SBP records, identifies sequences, and calculates linear correlation between RRI and SBP for each sequence. The mean of all individual regression coefficients (slopes), a measure of sequence BRS, is calculated for Sequence UP, DOWN and ALL (ms/mmHg). Blood pressure and heart rate are acquired from 10 minute recordings of noninvasive finger arterial pressure measurements and ECG with participants lying quietly, supine. Systolic BP and beat to beat, RR intervals files generated via the data acquisition system (BIOPAC acquisition system and Acknowledge 4.2 software, Santa Barbara, CA), at 1000 Hz, are analyzed using Nevrokard BRS software (Nevrokard BRS, Medistar, Ljubljana, Slovenia).
- Changes in Healthcare Utilization Survey [V3 (8-10 weeks following completion of the intervention for EI; V5 (8-10 weeks following completion of the intervention for DI)]
Clinic visit counts will be collected (ED, Urgent Care visits).
- Change in Electrogastrography (EGG) [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
Electrogastrography is the method of recording electrogastrograms or EGGs. EGGs record gastric myoelectrical activity (GMA). The rhythm of the GMA indicates normal or depleted numbers of interstitial cells of Cajal (ICCs), the pacemaker cells of the stomach. GMA also reflects the overall activity of gastric smooth muscles and nerves in response to a standard non-caloric or caloric test meal. This will be performed during WLST test.
- Change in Water Load Satiety Test (WLST) [Baseline to V3 (8-10 weeks following completion of the intervention for EI; Baseline to V5 (8-10 weeks following completion of the intervention for DI)]
The total volume of water consumed in mL will be recorded. A continuous 30-minute EGG recording is then obtained. The participant's symptoms are recorded using a visual analog scale at 10, 20, and 30 minutes after ingestion of the water (at the end of the 0-10 minute, 11-20 minute, and the 21-30 minute periods after the water load ingestion (post-satiety periods).
Subjects with chronic drug- refractory, nausea and vomiting (ages 18 and up)
Solid-phase gastric emptying studies show either normal gastric emptying or delayed gastric emptying
Referring physician will confirm eligibility based on Rome-IV criteria
Normal upper endoscopy or upper GI series and normal gallbladder tests
Stable gastrointestinal symptoms with total GCSI score of greater than or equal to 21
Ability to sign informed consent
Ability to comply with basic instructions and be able to sit still, comfortably during sessions
Willingness to complete the EGG and WLST
Non-gastrointestinal disorders which could explain symptoms in the opinion of the investigator
Active H pylori infection
Significant hepatic injury (elevated ALT, AST, bilirubin)
Metabolic, mechanical, or mucosal inflammatory causes to explain GI symptoms such as inflammatory bowel disease, celiac disease, liver or pancreatic disease, or bowel obstruction
Patients with significant cardiac or cardiovascular disease, malignancy, or other comorbid conditions
Use of narcotics more than three days per week or other drugs that affect motility (that cannot be held)
Previous diagnosis or history of orthostatic intolerance, e.g. POTS, neurocardiogenic syncope, orthostatic hypotension, etc.
Patients with pace makers
Use of beta blockers which can interfere with heart rate variability recording
Unable, unwilling, or incompetent to provide informed consent/assent
Physically unable to come to the study visits, or to sit still, comfortably in a chair for up to 1.5 hours
Severe hearing impairment (because the subject will be using ear buds during CR)
Anticipated and ongoing use of alcohol or recreational drugs
Weight is over the chair limit (400 pounds)
Currently enrolled in another active intervention research study
Prior use of: HIRREM, HIRREM-SOP, Brainwave Optimization (BWO), Cereset, Cereset Home, or a wearable configuration of the same (B2, or B2v2)
Prior use of the following modalities within one month before enrollment: electroconvulsive therapy (ECT), prior use of transcranial magnetic stimulation (TMS), transcranial direct current stimulation (TDCS), alpha stimulation, eye movement desensitization and reprocessing (EMDR), brain spotting, neurofeedback, biofeedback, or deep brain stimulation (DBS)
Known seizure disorder
Thoughts of suicide within the last 3 months
Contacts and Locations
LocationsNo locations specified.
Sponsors and Collaborators
- Wake Forest University Health Sciences
- Susanne Marcus Collins Foundation
- Gastroenterology Project
- Principal Investigator: Charles Tegeler, MD, Wake Forest University Health Sciences
Study Documents (Full-Text)None provided.
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