Deep Brain Stimulation for Alcohol Use Disorder
Limbic Pallidum Deep Brain Stimulation for the Treatment of Severe Alcohol Use Disorder
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Khaled Moussawi, MD, PhD
- Phone Number: 412-383-3084
- Email: moussawik@upmc.edu
Study Locations
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Pennsylvania
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Pittsburgh, Pennsylvania, United States, 15219
- University of Pittsburgh Medical Center
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adults (all genders) 21 to 75 years old.
- Severe primary Alcohol Use Disorder (AUD) (>= 6 Diagnostic and Statistical Manual-5 AUD criteria) with or without other substance use disorders.
- Participants are seeking treatment for their AUD (participants receiving medications or other therapy for AUD are eligible).
- Participants have insight into their alcohol use disorder (score >26 on the recognition subscale of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES V.8)).
- Participant has advanced compensated alcohol-associated liver disease (ALD). Compensated is defined as asymptomatic per clinical evaluation (by hepatologist or internist). Advanced is defined as fibrosis stage >= 3; if not previously diagnosed, fibrosis stage >= 3 will be diagnosed with liver elastography using a liver stiffness cutoff >=15kiloPascal
- AUD is treatment refractory: unable to achieve sustained remission (>12 months) over the past 5 years, despite treatment attempts, with at least one treatment attempt involving completed residential or outpatient treatment program with pharmacotherapy, behavioral therapy, or both.
- Stated willingness to comply with all study procedures and availability for the duration of the study.
- Social support system and stable living arrangement to provide assurances that the subject will adhere to study requirements: family or friends who live with or near the subject, and can provide collateral information, monitor the subject's behavior, support, and encourage the subject to participate in follow-up visits and evaluations. This is evaluated by a neuropsychologist.
- For females of reproductive potential: use of highly effective contraception for at least 4 weeks prior to DBS surgery and agreement to use such a method during study participation, and after study completion if they elect to keep the DBS system implanted and ON.
Exclusion Criteria:
- Pregnancy or lactation.
- Non-English speaking.
- AUD treatment with another investigational drug or other intervention within 3 months.
- History of primary psychosis or Bipolar I disorder per the psychiatric evaluation or Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders-5 measure.
- History of severe personality disorder that could interfere with study participation (e.g., antisocial personality disorder) per the psychiatric evaluation, neuropsychological evaluation, or Structured Clinical Interview for the Diagnostic and Statistical Manual-5 measure.
- Intelligence quotient <75 as measured by Wechesler Abbreviated Scale of Intelligence (evaluated by a neuropsychologist).
- History of suicidal attempts in the past 5 years or current suicidal thoughts per psychiatric evaluation and Columbia-Suicide Severity Rating Scale (C-SSRS).
- Decompensated ALD: clinically obvious ascites, hepatic encephalopathy, jaundice episodes, large esophageal varices with or without variceal bleeding, hepatorenal syndrome, per the clinical evaluation (by hepatologist or internist).
- Coagulopathy: international normalized ratio (INR) > 1.4, activated partial thromboplastin time (aPTT) > 40 s, platelets < 100,000.
- Current clinically significant medical or neurologic disease that affects brain function (e.g., recent stroke, myocardial infarction, seizures not due to alcohol withdrawal).
- Clinically significant abnormality on structural brain MRI scan.
- Life expectancy less than 18 months per the clinical judgement during medical evaluation (e.g., no terminal cancers).
- Any labeled DBS contraindication or inability to have brain MRI: certain pacemakers, metal in body, inability to undergo awake operation, significant cardiac or other medical risk factors for surgery, infection, and coagulopathy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: AUD DBS
This is a single arm study.
Participants will undergo baseline medical and psychiatric assessments, cognitive and behavioral testing, and positron emission tomography (PET) imaging.
One to two weeks later, participants will undergo neurosurgical implantation of DBS electrodes in the limbic pallidum and a neurostimulator.
Four weeks after DBS system implantation, the DBS system will be turned ON and the stimulation parameters optimized.
Participants will be followed biweekly then monthly for repeat comprehensive assessments.
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Bilateral DBS electrodes will be implanted into the limbic pallidum of participants with severe alcohol use disorder and advanced but compensated liver disease.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Number of Serious Adverse Events (Safety and Tolerability)
Time Frame: 4-52 weeks
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This will be evaluated based on number and seriousness of adverse events associated with DBS implantation and stimulation (e.g., infection, bleeding, cognitive or behavioral side effects).
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4-52 weeks
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Recruitment (Feasibility)
Time Frame: 0-71 weeks
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This will be evaluated based on number of participants recruited and enrolled in the study between study start date and primary completion date.
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0-71 weeks
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Proportion of Completed Assessments (Feasibility)
Time Frame: 4-52 weeks
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This will be evaluated based on the average percentage of evaluations completed across participants during the study duration out of total required assessments to measure the participants' adherence to the study protocol.
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4-52 weeks
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Overall Functioning
Time Frame: 6 months
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Overall function and disability will be measured using standardized questionnaire World Health Organization Disability Assessment 2.0 (WHODAS2.0)
score before and after DBS activation (raw score 0-180, higher is worse).
The focus of analysis was limited to the 6-month timepoint.
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6 months
|
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Alcohol Use - Percent Days Abstinent
Time Frame: 6 months
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assessment of alcohol use will be measured through percent days abstinent (PDA) at baseline (pver preceding 6 months) and at 6 months after DBS activation.
PDA at baseline is assessed over the preceding 180 days.
PDA at 6 months post-DBS activation is assessed over the preceding 30 days.
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6 months
|
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Alcohol Use - Drinks Per Drinking Day
Time Frame: 6 months
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assessment of alcohol use will be measured through drinks per drinking day (DDD) before and after DBS activation.
The focus of analysis was limited to the 6-month timepoint.
DDD at baseline is assessed over the preceding 180 days.
DDD at 6 months post-DBS activation is assessed over the preceding 30 days.
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6 months
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Target Engagement
Time Frame: 6 months
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This will be assessed by measuring the percent change in brain metabolism with 18fluoro-Deoxy-Glucose (FDG) PET scans before and after DBS activation.
The timepoint 4 weeks post-surgery was excluded because breath alcohol test was positive on that day.
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6 months
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Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Cue Reactivity Craving Score
Time Frame: 6 months
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To measure subjective craving after presentation of alcohol or neutral pictorial cues pre and post DBS.
Craving is reported using a visual analog scale (VAS) between 0 and 100, where 100 indicates very high craving; the cue reactivity craving score is calculated as the difference in craving scores after alcohol vs. neutral pictures.
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6 months
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Khaled Moussawi, MD, PhD, University of Pittsburgh
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Estimated)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- STUDY22030036
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
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