Bilateral Closed Loop Deep Brain Stimulation for Freezing of Gait Using Neural and Kinematic Feedback
Study Details
Study Description
Brief Summary
Deep Brain Stimulation of the subthalamic nucleus (STN) has become a standard of care, FDA-approved treatment for Parkinson's disease, with stimulation delivered at a constant amplitude and voltage, operating in an open-loop fashion that does not respond to a patient's current state. Although gait deficits and freezing of gait may initially respond to continuous open-loop deep brain stimulation (olDBS) and medication, the symptoms often recur over time.
The episodic and predictable nature of FOG makes it well suited for adaptive DBS (aDBS) and a device that overcomes the limitations of traditional high frequency olDBS and is capable of adapting therapy either in the frequency or intensity domain transiently to treat FOG while also treating other PD signs such as tremor and bradykinesia.
The purpose of this study is to determine the feasibility of an adaptive DBS system, that responds to patient-specific neural and kinematic variables with customized DBS parameters.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Study Design
Outcome Measures
Primary Outcome Measures
- Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] related to Stimulation Condition [5 years]
A Customized Adverse Events and Tolerability Questionnaire will measure the absence/presence and frequency of paresthesias, and muscle twitching relative to each stimulation condition
- Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] related to quality of life [5 years]
The MDS-UPDRS Parts I, II, and IV will: (I) Evaluate mentation, behavior, and mood (II) Evaluate a patient's activities of daily life (IV) Measure the presence/severity of dyskinesias and other complications of therapy related to each stimulation condition.
- Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] related to speech [5 years]
The Speech Intelligibility Test (SIT) will measure changes in speech related to each stimulation condition.
- Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] related to gait [5 years]
The Freezing of Gait Questionnaire (FOG-Q) will be used to record changes in gait related to each stimulation condition
Eligibility Criteria
Criteria
Inclusion Criteria:
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Clinically-established PD
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Meets criteria for STN DBS eligibility as part of patient's standard medical care
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The presence of complications of medication such as wearing off signs, fluctuating responses and/or dyskinesias, and/or medication refractory tremor, and/or impairment in the quality of life on or off medication due to these factors.
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Ability and willingness to return for study visits, at the initial programming and after three, six and twelve months of DBS.
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Age > 25
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Freezing of gait questionnaire (FOG-Q) score ≥ 1 and/or gait sub-score (Item 3.10) of MDS- UPDRS III ≥ 1
Exclusion Criteria:
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Dementia
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Untreated psychiatric disease
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Hoehn and Yahr stage 5 on or off medication (non-ambulatory)
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Age > 80
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Major surgical morbidities such as severe hypertension, coagulopathy and certain metabolic conditions that might increase the risk of hemorrhage or other surgical complications
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Presence of a cardiac pacemaker/defibrillator
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Inability to understand/sign consent
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Requires rTMS, ECT, MRI, or diathermy
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Are pregnant or lactating
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Has a cranial metallic implant
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Stanford University | Stanford | California | United States | 94305 |
Sponsors and Collaborators
- Stanford University
Investigators
- Principal Investigator: Helen M. Bronte-Stewart, MD,MSE, Stanford University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 52548