Deep Brain Stimulation for Patients With Chronic, Severe and Resistant Anorexia Nervosa

February 20, 2020 updated by: Víctor Pérez, Parc de Salut Mar

Deep Brain Stimulation on the Subgenual Cingulate and Accumbens Nucleus for Patients With Chronic, Severe and Resistant Anorexia Nervosa

Deep brain stimulacion (DBS) clinical study in the subcallosal cingulate (CSG) and accumbens nucleus (NAc) for 8 patients with treatment-refractory, cronic and severe anorexia nervosa (AN) patients. The main objective is to show efficacy and safety. Studies show that SSG and NAc are strategical targets in the pathophysiology and the hypothetical surgical treatment in AN patients. The patients distribution (4 patients in each target) it will made by the AN type and the comorbidity associated, the reasons are: 1- It is well known the comorbidity treatment imoportance in the AN evolution, 2- The two differentes types of AN have differents clinical behaviour and prognosis, 3- Studies show efficacy in TOC and DM patients with NAc DBS and in DM patients with CSG DBS. The main variable is BMI. After a 6 months stabilization evaluation phase will be followed (only in patients that have increase 10% BMI) by a double-bind, crossover phase, where patients will receive 3 months with stimulation turned on and 3 month with turned off. All patients will have a 12 months follow up. The study secondary objectives are to know the relation btween the stimulacion answer (increase 10% BMI) and the differents variables, specially AN type, associated cormobidity, selected target and preoperative MRI tractography study.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Unknown

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

HYPOTHESIS OF THE CLINICAL TRIAL

Based on the results of functional, preclinical, clinical and neurocircuit imaging studies in patients with Anorexia Nervosa (AN) and in the results of deep brain stimulation (DBS) in 81 other mental illnesses and in AN, our main hypotheses are:

  1. The subgeneric cingulate (CSG) and nucleus accumbens (NAc) are strategic targets in AN patients, so deep brain stimulation in these two targets may be effective in the treatment of AN patients.
  2. The stimulation of the CSG and the NAc has been safe in other mental illnesses so it can also be in patients with AN.

VARIABLES

The variables to be studied are: age, years of illness, number of admissions, type of AN, drugs tested, drugs at the present time, non-pharmacological treatments received, weight and current BMI, weight and mean BMI of the last year, associated comorbidity, Hamilton Scale for Depression (HAMD-17), Hamilton Scale for Anxiety (HAMA), Obsessive Compulsive Yale-Brown Scale (YBOCS), Cornell Scale for Eating Disorder (YBC-EDS), Quality of Life Scale SF-36, stimulation variables (voltage, frequency, pulse amplitude, active contacts), stimulated target (CSG, NAc), complications.

The main variable is the Body Mass Index (BMI). The baseline will be the mean BMI of the last 3 months pre-dating.

The variables will be collected preoperatively, after the surgery on a monthly basis until the end of the 12 months of follow-up from the surgery, and in the last month of follow-up of the study (month 33 of the study). Patient visits will be every 2 weeks from the start of the stimulation to 12 months of follow-up.

Response and referral criteria. Response to treatment is considered if BMI increases at least 10% of baseline BMI (baseline BMI: the mean of the last 3 months pre-engagement). Remission is considered if the BMI is greater than 18.5. The type of response in the associated comorbidities will be studied as a variable, but not as a criterion of response to treatment.

Concomitant treatments during the study: Patients will continue with the pharmacological treatment and with the previous psychotherapeutic therapies. During the study, modification of the drugs will not be allowed, but a dose adjustment if not an increase of more than 50%. All this must be recorded on the data collection sheet in the usual way. A new psychotherapeutic therapy can not be initiated during the study, and if it is done, the patient would leave the study.

Rescue measures against side effects of stimulation. The complication rate is very low (1-4%). In case of an infectious complication, the patient will receive antibiotic treatment. In case of a neurological complication (comitial crisis, feeling of discomfort), the generator can be turned off and restarted once the complication is resolved.

Rescue measures if clinical worsening in the off phase of double-blind. The generator will be connected, and the patient leaves the double-blind phase.

Rescue measures if worsening AN or some of their comorbidities (patient under stimulation). Pharmacological dose adjustment is permitted if it is not an increase of more than 50%, in case of having to be done, the patient would leave the study. It would not be possible to initiate a psychotherapy in which the patient was no longer present and, if required, the patient would leave the study.

Criteria for modifying the stimulation variables. There are two criteria that can modify the stimulation parameters: that there is no response to treatment (BMI), or that there is a side effect related to the stimulation (for example, a crisis in the hospital, discomfort). Changes in patient comorbidity will not be a criterion for modifying pacing parameters.

STAGES OF THE STUDY

Stage 1 (Documentation and recruitment). Its duration is 3-6 months. At this stage, all necessary documentation will be processed and the patients included in the study will be recruited, following the inclusion and exclusion criteria described below.

Stage 2 (Preoperative Evaluation, Surgical Intervention and Follow-up). This stage comprises month 4 to month 33 of the study. Once the patient was included in the study, with confirmation of the evaluation committee, and having received informed consent of the patient, the preoperative evaluation will be performed (Brain Resonance with tensor tractography, general analysis, chest x-ray, Electrocardiogram, psychometric tests, weight, body mass index, and neuropsychological evaluation). The period for the surgical procedure comprises month 4 to month 22 of the study, since all patients will be evaluated during a follow-up period of at least 12 months, and after a follow-up period, a period of evaluation of the results (3 months) is required. All surgeries and follow-up will be performed at the Hospital del Mar. In surgery, two cerebral electrodes (either in the Subgenual cingulate or in the Accumbens Nucleus) are connected to a subcutaneous generator at abdominal fat level, under general anesthesia, the hospitalization time is 3-4 days. The patient will initiate the stimulation of the stimulation system implanted prior to discharge. The patient will have control visits every 2 weeks (face-to-face or telephone) and monthly at the Hospital del Mar for the evaluation of scales, weight and possible side effects during the study's duration (minimum 1 year per patient). The patient will undergo an intraoperative cerebral CT scan and an immediate postoperative CT scan. Neuropsychological evaluation will be performed preoperatively and after 6 months of treatment. The follow-up stage of the patients in the study comprised month 4 of the study and month 33 of the study.

Stage 3 (Double Blind). This stage comprises a period of 6 months. After 6 months of stimulation, patients responding to stimulation (10% or greater increase in BMI compared to the mean BMI of the last 3 months of pre-engagement) will go on to a double-blind phase, in which 3 Months in on and 3 months in off, or vice versa (assigned by envelopes prior to the start of surgeries). Those patients who are in the off and worsen group (5% decrease in BMI from baseline) will be rescued by reestablishing the stimulation, and leaving the cross-study phase.In order to preserve masking, the CoiP (neurosurgeon, responsible for programming), will decide the changes in the stimulation remaining unrelated to the evaluation of the patients.

Stage 4 (Total collection of data and conclusions). This stage comprises from month 34 to month 36 of the study (last month of the project's 3 years).

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Anticipated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
8

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

(All criteria for inclusion must be met)

  1. Age between 18-60 years
  2. Diagnosis of AN, both restrictive type and compulsion / purge type defined by the DSM-V-TR
  3. Chronicity: minimum of 10 years of illness.

  4. Resistance to treatment, shown by one or both of the following situations:

    A. That of the multiple treatments performed, at least 1 is an intensive treatment (hospitalization or day hospital), with one or more of the following results:

    • I have not been able to finish the treatment.
    • That it has finished but with little or no answer.
    • That in spite of having finished it, and of having answered, Has found a subsequent relapse in the first six months. B. Clinical situation of medical instability, accompanied by refusal to participate in any treatment program and including at least 1 episode of admission for involuntary feeding.
  5. Extremely serious (BMI less than 15), or severe (BMI between 15-15,99)
  6. Ability to sign informed consent
  7. Ability to undergo all tests and follow-ups of the study

Exclusion Criteria:

  1. BMI less than 13 at the time of recruitment for the study.
  2. Psychosis in the present moment or in the past.
  3. Current neurological disease.
  4. Substance or alcohol abuse and dependence in the last year.
  5. Contraindications to perform a brain MRI
  6. Presence of cardiac arrhythmias or other cardiac, respiratory, renal or endocrine affections, as a result of AN or not, that carries risk for the surgical procedure.
  7. Pregnancy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Deep brain stimulation ON
Surgical procedure is necessary.In surgery, two cerebral electrodes (either in the Subgenual cingulate or in the Accumbens Nucleus) are connected to a subcutaneous generator at abdominal fat level, under general anesthesia. The patient will initiate the stimulation prior to discharge . At 6 months follow up, Deep brain stimulation continue 3 months more activated, patient and psychiatrist don´t know
Device: Deep brain stimulation ON
Infinity model of deep brain stimulation is placed ( 2 brain elecrodes and subcutaneus generator ) under general anhestesia. The system is activated
Other Names:
  • Deep Brain Stimulation: Infinity model device (ON)
Experimental: Deep brain stimulation OFF
Surgical procedure is necessary.In surgery, two cerebral electrodes (either in the Subgenual cingulate or in the Accumbens Nucleus) are connected to a subcutaneous generator at abdominal fat level, under general anesthesia. The patient will initiate the stimulation prior to discharge . At 6 months follow up, Deep brain stimulation is stopped during 3 months , patient and psychiatrist don´t know
Device: Deep brain stimulation OFF
Infinity model of deep brain stimulation is placed ( 2 brain elecrodes and subcutaneus generator ) under general anhestesia. The system is not activated
Other Names:
  • Deep Brain Stimulation: Infinity model device (OFF)

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Body mass index (BMI)
Time Frame: From baseline till 12 months
BMI will be measured monthly from baseline till 12 months. Data will be compared with BMI in the beginning of the open label period
From baseline till 12 months

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Adverse events during the study
Time Frame: From baseline till 12 months
From baseline till 12 months
Psychiatric comorbidity
Time Frame: From baseline till 12 months
Psychiatric comorbidity will be measured monthly from baseline till 12 months
From baseline till 12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Parc de Salut Mar

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Study Director: Gloria Villalba Martínez, Doctor, Parc de Salut Mar

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
May 23, 2017

Primary Completion (Anticipated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
March 17, 2020

Study Completion (Anticipated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 17, 2020

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 25, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 25, 2017

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
May 30, 2017

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
February 21, 2020

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 20, 2020

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
February 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • ECP-AN-2016-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Anorexia Nervosa

Clinical Trials on Deep brain stimulation ON

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Cookie Settings

We use cookies to ensure that we give you the best experience on our website. For more details carefully read our Privacy and Cookies Policy. ...>>>You can change your preferences or withdraw your consent at any time by deleting the cookies from your website or computer as described in the policy. Please accept it and choose your preferences by ticking the corresponding boxes in the "Manage Settings" section below. Please carefully read our Terms of Service before you proceed with using any part of this website.
«Manage Settings