- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02424929
Asleep Versus Awake Deep Brain Stimulation Surgery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
All patients will undergo DBS surgery using regular surgical techniques. In this surgery a halo is attached to the skull. A CT scan is obtained. MRI - based targeting is conducted to identify to target location to implant the electrode deep in the brain. The patients have a burr hole placed just behind their hair line in the frontal lobe. Then a guide tube is inserted in the brain. Neurophysiological identification and confirmation of the target is conducted with multiple techniques including microelectrode recording to listen to single neurons in the brain, and macrostimulation to test clinical effect. The electrode is implanted and its clinical effect is tested. The halo is removed and the patient is taken to the recovery room. Patients will be randomized to undergo the surgery awake or asleep. Our current standard surgical technique is awake with intravenous anesthesia used briefly during drilling of a burr hole in the skull.
But in selected cases patients have remained sedated throughout the entire surgery. Patients in the asleep group will have intravenous anesthesia maintained throughout the entire case.
Standard intraoperative neurophysiological and imaging techniques will be used. In awake patients these techniques are used to identify and confirm that the DBS electrode is implanted in accurate position. These techniques include microelectrode recording where individual neurons are monitored as the electrode is inserted through the brain tissue. Early research reports suggest that sedation may affect the neuronal activity. But our preliminary data indicates that is still reliable under intravenous anesthesia. Macrostimulation using the implanted DBS electrode can suppress tremor, stiffness, and slowness of Parkinson's disease, and assists in confirmation of electrode position. It also causes side effects including tingling, and facial contractions. These methods will also be studied in the asleep patients. The O-arm is an intraoperative CT scanner that visualizes the DBS electrode. O-arm images will be obtained in the standard fashion in both groups. The accuracy of intraoperative imaging will be compared to standard postoperative MRI. The clinical outcome from these two techniques will be compared. The clinical outcome will be measured with standard Parkinson's disease research tools including video taped and independently rated motor exam, as well as the Unified Parkinson's Disease Rating Scale (UPDRS). Gait analysis will be collected using the APDM system. These will be tested before and at 3 months after surgery by the neurologist.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Washington
-
Spokane, Washington, United States, 99204
- Recruiting
- Providence Inland Neurosurgery & Spine
-
Contact:
- Jonathan D Carlson, M.D. PhD.
- Phone Number: 509-624-9112
- Email: jonathan.carlson@providence.org
-
Principal Investigator:
- Jonathan D Carlson, MD PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All patients will have moderate to advanced Parkinson's disease.
- Patients must be medically safe for asleep or awake surgery.
- Ability to speak English well.
Exclusion Criteria:
- Parkinson's patients with concurrent dementia as measured by neurocognitive testing, or with significant strokes identified on MRI will be excluded. Other similar diseases will be excluded from the study such as Essential Tremor, and Parkinson's plus disorders.
- Patients that are obese or that have severe potential airway issues.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Awake
Original surgery intervention. Patient will have DBS surgery done in the normal fashion. Asleep for the drilling of the burr holes, then awakened for the placement of the electrodes. No intervention will be given. |
No intervention, surgery will be conducted as usual.
With sedation only during the drilling of the burr holes.
|
Other: Asleep
Sedation intervention. Surgical intervention, anesthesia will be administered during entire placement of the system. Patient will not be awake at any point during procedure. All other aspects of surgery will be conducted normally. |
Propofol anesthesia administered during entire surgery.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Lead Placement
Time Frame: 6 months post operation
|
Determination of location of lead placement and efficacy of programming.
x,y,z coordinates related to the anterior commissure and posterior commissure.
|
6 months post operation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Stimulation Parameters
Time Frame: 6 months post operation
|
Record stimulation settings.
Contacts, voltage, frequency, pulse width.
|
6 months post operation
|
Unified Parkinson's Disease Rating Scale-UPDRS
Time Frame: 1 month pre-operation and 6 month post operation
|
Compare UPDRS score pre and post surgery
|
1 month pre-operation and 6 month post operation
|
Medication Data
Time Frame: 1 month pre-operation and 6 month post operation
|
Compare medication dosage pre and post surgery; mg per dose, dose frequency, total dose, L-dopa equivalent.
|
1 month pre-operation and 6 month post operation
|
Operation Data
Time Frame: Day of operation
|
Microelectrode recordings Anesthesia record; anesthesia dose in reference to Ramsay Scale Stimulation side effects; where parasthesias are present (arm, leg, face), tremor, eye deviation, rigidity, hand speed.
|
Day of operation
|
Mobiltiy Lab
Time Frame: 1 month pre-operation and 6 month post operation
|
Gait evaluation; jerkiness, time-domain (m/s^2, Hz), Frequency, temporal gait, cadence, stride length, range of motion, asymmetry, turning time, number of steps, anticipatory postural amplitude, duration.
|
1 month pre-operation and 6 month post operation
|
Collaborators and Investigators
Investigators
- Principal Investigator: Jonathan D Carlson, M.D Ph.D., Inland Neurosurgery and Spine
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1994
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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