Short and Long-term Responses of PD Symptoms to Earstim

Multicenter Study of Safety and Effectiveness of Auricular Muscle Zone Stimulation With the EarStim Novel Device for Parkinson's Disease

This is a prospective, multicenter, randomized, two-period study designed to evaluate the safety and effectiveness of the EarStim System for intermittent relief of motor symptoms in patients with Parkinson's disease experiencing wearing-off phenomena. Adult patients with moderate to severe Parkinson's disease (MDS-UPDRS Part III score ≥33) receiving oral dopaminergic therapy will be enrolled. Period A is a randomized, double-blind, sham-controlled phase conducted in a clinical setting. Period B is an unblinded, standard-of-care-controlled phase evaluating the effectiveness of the EarStim System during home use over 90 days.

Study Overview

• Status: Recruiting
• Conditions: PARKINSON DISEASE (Disorder)
• Intervention / Treatment: Device: EarStim; Device: EarStim + Standard of care (SOC); Device: Sham device; Other: Standard of Care (SOC)

Detailed Description

Parkinson's disease (PD) is the second most common neurodegenerative disorder, affecting approximately 0.3% of the general population and up to 3% of individuals over 65. It is characterized by cardinal motor symptoms such as bradykinesia, rigidity, tremor, and postural instability. While levodopa remains the gold-standard treatment, long-term use often leads to motor complications, including fluctuations between "ON" and "OFF" states. Deep brain stimulation of the subthalamic nucleus is an effective intervention for motor symptoms and medication-induced complications; however, axial symptoms such as postural instability and gait disturbances remain resistant to treatment. Alternative approaches, including peripheral nerve stimulation, have been explored to modulate motor control regions of the brain, offering potential benefits for PD symptom management.

The EarStim System, developed by Stoparkinson Healthcare Systems, is a wearable, non-invasive electro-stimulator designed to target intrinsic auricular muscle zones (IAMZ). These zones are innervated by the trigeminal, facial, vagus, and C2 spinal nerves, creating connections with motor regulatory pathways in the brainstem and basal ganglia. Pilot studies suggest that high-frequency stimulation of IAMZ can alleviate PD motor symptoms beyond the stimulation period.

This study aims to evaluate the safety and effectiveness of the EarStim System for intermittent symptom relief in PD patients. The study is a prospective, multi-center, randomized, two-period, non-significant risk pivotal study involving patients with PD experiencing wearing-off phenomena. It is designed to assess the safety and effectiveness of the EarStim System for the intermittent relief of motor symptoms. The study will recruit adult patients with moderate to severe PD, defined as an MDS-UPDRS Part III score of ≥33, who are being treated with oral dopaminergic medication.

The study consists of two periods: Period A and Period B. Period A will be a double-blind, randomized, sham-controlled part to assess the safety and effectiveness of the EarStim System in a clinical setting at Visit 1 (Day 0). Period B will be unblinded and controlled by a SOC arm to evaluate the effectiveness of the EarStim System in a home setting over a 90-day period.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yusuf Özgür Çakmak, MD, PhD, Assoc.Prof; Phone Number: 02108797738; Email: ycakmak@stoparkinson.com

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye), 34010
    • Recruiting
    • Koç University Hospital
    • Contact: Fatoş Sibel Ertan, MD, Professor of Neurology; Phone Number: +902124678700; Email: sertan@ku.edu.tr
    • Principal Investigator: Fatoş Sibel Ertan, MD, Professor of Neurology
  • Istanbul, Turkey (Türkiye)
    • Not yet recruiting
    • Şişli Hamidiye Etfal Research and Training Hospital
    • Contact: Gençer Genç, MD, Professor of Neurology; Phone Number: +902123735000; Email: gencerg@gmail.com
    • Principal Investigator: Gençer Genç, MD, Professor of Neurology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Patients fulfilling the following criteria are eligible for participation:

• Subject must be ≥44 years of age.
• Subject has PD and is on stable carbidopa/levodopa therapy for at least four weeks prior to enrollment in the study.
• Subject must be willing and able to refrain from changing PD medications or dosages during the 90-day study.

• Subject reports experiencing both "ON" and "OFF" episodes (MDS-UPDRS Part IV - Time Spent in the OFF-state score ≥1), as assessed and determined by the investigator.

  *This corresponds to item 4.3 in MDS-UPDRS Part IV, where a score of 0 (zero) indicates that the subject experiences no OFF periods during the waking day, and a score of ≥1 reflects the presence of OFF periods at any level.

• Subject experiences "OFF" periods with an "ON" score that is ≥20% better than the "OFF" score, as measured by the MDS-UPDRS Part III score, 1 hour after taking their dose of carbidopa/levodopa.
• Subject has an MDS-UPDRS Part III score ≥33 in "OFF" period.
• Subject agrees to remain in an "OFF" period for up to 3 hours without requiring rescue medication.
• Subject can walk independently, without the use of an assisted device (e.g., cane or walker), in both "ON" and "OFF" periods.
• Subject is willing to provide informed consent to participate in the study.
• Subject is willing and able to comply with all study procedures and required availability for study visits.

Exclusion Criteria:

Patients who meet any of the following criteria are to be excluded from participation:

• Subject has a medical or psychiatric comorbidity that may compromise participation in the study.
• Subject has a history of cardiac rhythm disorders (e.g., atrial fibrillation, ventricular tachycardia, or atrioventricular block).
• Subject is pregnant or planning to become pregnant during the course of the study.
• Subject has a form of Parkinsonism other than PD, such as drug-induced Parkinsonism or Multiple System Atrophy.
• Subject is currently using on-demand medications for PD, such as subcutaneous apomorphine, sublingual apomorphine, and levodopa inhalation powder.
• Subject has an implanted deep brain stimulator (DBS).
• Subject is receiving direct intestinal infusions of levodopa.
• Subject has a history of epilepsy.
• Subject's medications are expected to change during the 90-day study period.
• Subject has a cardiac pacemaker, defibrillator, bladder stimulator, spinal cord stimulator, or any other active electronic medical device.
• Subject is unable to understand or follow the instructions required by the study.
• Subject has an ear infection or skin condition around the ear.
• Subject is participating, or has participated, in another interventional clinical trial in the last 30 days that may confound the results of this study, unless approved by the Sponsor.
• Subject has a history of brain surgery or peripheral neuropathy.
• Subject is actively using TENS or has a history of chronic TENS use within the last 2 weeks prior to study enrollment.
• Subject consumed alcohol or caffeine within 12 hours of study enrollment or has a history of alcohol dependence

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Active arm (Period A); Patients in the active arm in Period A will wear the investigational EarStim System	Device: EarStim; Patients in the active arm in Period A will wear the investigational EarStim System; Device: EarStim + Standard of care (SOC); Participants in the active arm in Period A who are responders to stimulation (based on reduction in MDS-UPDRS III scores) will proceed to Period B, which takes place in a home setting. In Period B, these responders will be assigned to "EarStim + SOC" group. They will be instructed to continue their oral dopaminergic medications as usual, and in addition, to use EarStim stimulation at home at the time of their medication intake.
Sham Comparator: Sham arm (Period A); Patients in the sham arm in Period A will wear an identical device with no active stimulation.	Device: Sham device; Patients in the sham arm in Period A will wear an identical device with no active stimulation, programmed in similar manner as the EarStim system; Other: Standard of Care (SOC); Participants from the sham arm of Period A will be assigned to the "SOC" group and will continue their oral dopaminergic medications as usual, without any EarStim stimulation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adverse events	Frequency of all adverse events	From enrollment to the end of study at 90 days
Change in Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III scores	Comparison of reduction in the MDS-UPDRS Part III scores from pre-stimulation to 40 minutes post-stimulation between active and sham arms during Period A. 18 items, 0-4 rating scale (from normal to worse).	40 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III score	Comparison of reduction in the MDS-UPDRS Part III scores from pre-stimulation to 90 minutes post-stimulation, comparing the active and sham arms during Period A (Visit 1). 18 items, rating 0-4 score for each item (from normal to worse)	90 minutes
Change in Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III score	Mean reduction in the MDS-UPDRS Part III score from pre-stimulation to 40 minutes post-stimulation in the EarStim + SOC group compared with SOC group at Visit 2,3,4. 18 items, rating 0-4 score for each item (from normal to worse)	From 30 days (Visit 2) to 90 days (Visit 4)
Change in Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III score	Non-inferiority of the mean reduction in the MDS-UPDRS Part III score from pre-stimulation to 40 minutes post-stimulation in the EarStim + SOC group at Visit 4 compared with the active group at Visit 1. 18 items in scale, 0-4 rating score for each item (from normal to worse)	90 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parkinson's KinetiGraph (PKG™)	Changes in PKG™ sleep and nighttime activity levels from pre-Visit 1 scores to the mean scores of Visits 2, 3, and 4.	From baseline up to 90 days (Visit 4)
Parkinson's KinetiGraph (PKG™)	Changes in PKG™ motor fluctuations from pre-Visit 1 scores to the mean scores of Visits 2, 3, and 4.	From baseline up to 90 days (Visit 4)
Parkinson's KinetiGraph (PKG™)	Changes in PKG™ bradykinesia, dyskinesia, and tremor from pre-Visit 1 scores to the mean scores of Visits 2, 3, and 4.	From baseline up to 90 days (Visit 4)
Patient Global Impression - Change (PGI-C) scale	Comparison of Patient Global Impression - Change (PGI-C) scale scores between the active and sham arms after 40 minutes of stimulation at Visit 1. one question, response rated on a 7-point scale, ranging from 1 = Very much improved to 7 = Very much worse	40 minutes
Clinical Global Impression - Change (CGI-C) scale	Comparison of Clinical Global Impression - Change (CGI-C) scale scores between the active and sham arms after 40 minutes of stimulation at Visit 1. One question, responses rated on a 7-point scale, from better to worse.	40 minutes
Parkinson's Disease Questionnaire (PDQ-8)	Comparison of PDQ-8 scores between the "EarStim + SOC" and "SOC" groups at Visits 2, 3, and 4. 8 item scale, responses rated for each item from 0 (never) to 4 (always), with higher scores indicating a greater impact of disease on daily life.	From 30 days (Visit 2) to 90 days (Visit 4)
Parkinson's Disease Questionnaire (PDQ-8)	Comparison of PDQ-8 scores in the "EarStim + SOC" group at Visits 2, 3, and 4 versus the day before Visit 1. 8 item scale, responses rated for each item from 0 (never) to 4 (always), with higher scores indicating a greater impact of disease on daily life.	From Day -1 to 90 days (Visit 4)
Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part II scores	Comparison of the MDS-UPDRS Part II (Motor Aspects of Experiences of Daily Living) scores in the "EarStim + SOC" group between Visit 4 and Visit 1. 13 items, responses for each item scored on a 0-4 rating scale (from 0: normal to worse)	From Day 0 (Visit 1) to Day 90 (Visit 4)
Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part I scores	Comparison of the MDS-UPDRS Part I (Non-Motor Aspects of Experiences of Daily Living) scores in the "EarStim + SOC" group between Visit 4 and Visit 1. 13 items, responses for each item rated 0-4 (0 being normal to worse)	From Day 0 (Visit 1) to Day 90 (Visit 4)
Wearing-off Questionnaire (WOQ-9)	Comparison of Wearing-off Questionnaire (WOQ-9) scores between pre-Visit 1 and Visits 2, 3, and 4. 9 items of questionnaire.	From baseline up to 90 days (Visit 4)
Change in Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III score	Assessment of whether the mean reduction in the MDS-UPDRS Part III score from pre-stimulation to 40 minutes post-stimulation in the active arm at Visit 1 is clinically meaningful (≥3.2 points). 18 items in scale, each item responded 0-4 rating score (from normal to worse)	40 minutes
Change in Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III score	Assessment of whether the mean reduction in the MDS-UPDRS Part III score from pre-stimulation to 90 minutes post-stimulation in the active arm at Visit 1 is clinically meaningful (≥3.2 points). 18 items in scale, 0-4 rating score for each item (from normal to worse)	90 minutes
Change in Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III score	Assessment of whether the mean reduction in the MDS-UPDRS Part III score from pre-stimulation to 40 minutes post-stimulation in "EarStim+SOC" group, combined across Visit 2,3,4 is clinically meaningful (≥3.2 points). 18 items in scale, 0-4 rating score for each item (from normal to worse)	From Day 0 (Visit 1) up to 90 days (Visit 4)

Collaborators and Investigators

• Sponsor: Stoparkinson Healthcare Systems LLC
• Investigators: Study Director: Yusuf Özgür Çakmak, MD, PhD, Assoc.Prof, Stoparkinson Healthcare Systems LLC

Study record dates

Study Major Dates

• Study Start (Actual): March 12, 2026
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): February 1, 2027

Study Registration Dates

• First Submitted: February 3, 2026
• First Submitted That Met QC Criteria: February 3, 2026
• First Posted (Actual): February 10, 2026

Study Record Updates

• Last Update Posted (Actual): April 23, 2026
• Last Update Submitted That Met QC Criteria: April 22, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: parkinson disease; intrinsic auricular muscle zone stimulation; IAMZ
• Additional Relevant MeSH Terms: Synucleinopathies; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurodegenerative Diseases; Movement Disorders; Parkinsonian Disorders; Basal Ganglia Diseases; Parkinson Disease; Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: STP-PD-006

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
• product manufactured in and exported from the U.S.: No