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CUSTOM-DBS: Current Steering to Optimize Deep Brain Stimulation (CUSTOM-DBS)

17. november 2020 opdateret af: Boston Scientific Corporation

Current Steering to Optimize Deep Brain Stimulation

The objective of the study is to compare different deep brain stimulation (DBS) settings using the commercially approved Boston Scientific Neuromodulation Vercise system.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

The study is a prospective, multi-center, double-blind, randomized controlled trial.

This study will compare various program settings for the bilateral stimulation of the STN using the BSC implantable Vercise™ DBS System for the treatment of levodopa-responsive, moderate to severe idiopathic PD.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

40

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Det Forenede Kongerige
      • Bristol, Det Forenede Kongerige
        • Southmead Hospital Bristol
      • London, Det Forenede Kongerige
        • Charing Cross Hospital
  • Forenede Stater
    • California
      • Valencia, California, Forenede Stater, 91355
        • Boston Scientific Clinical Research Information Toll Free Number
  • Italien
      • Udine, Italien
        • Osp. S. Maria Della Misericordia
  • Tyskland
      • Berlin, Tyskland
        • University Berlin, Charite Virchow
      • Düsseldorf, Tyskland
        • Universitaetsklinikum Dusseldorf
      • Kiel, Tyskland
        • Universitätsklinikum Campus Kiel
      • Köln, Tyskland
        • Uniklinik Koln
      • Wurzburg, Tyskland
        • Universitaetsklinikum Wuerzburg
  • Østrig
      • Innsbruck, Østrig
        • A.o. LKH Univ.-Kliniken Innsbruck

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Implanted bilaterally in STN with a Vercise DBS system for Parkinson's disease for at least three months with programming optimized according to standard of care.
  • UPDRS subset III score of ≥30 in the in the pre-operative meds off state.
  • DBS must improve PD symptoms by ≥30% in the meds off state, as measured by UPDRS subset III score.
  • Medical and mental fitness to comply with programming visit and study related procedures.
  • Able to understand the study requirements and the treatment procedures and provides written informed consent before any study-specific tests or procedures are performed.
  • Off symptom rigidity score of ≥2 in the evaluated arm as determined by the UPDRS-III.

Exclusion Criteria:

  • Have any significant medical condition that is likely to interfere with study procedures or likely to confound evaluation of study endpoints, including any terminal illness with survival <12 months.
  • Resting and/or action tremor score of ≥3 on the evaluated side as determined by the UPDRS-III in pre-operative meds off condition.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Grundvidenskab
  • Tildeling: Randomiseret
  • Interventionel model: Crossover opgave
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Short PW
Patients with a Vercise DBS system programmed to 30 microseconds pulse width
Enhed: Vercise DBS settings
Deep brain stimulation set at short pulse width and monopolar stimulation using current steering
Eksperimentel: Conventional PW
Patients with a Vercise DBS system programmed to 60 microseconds pulse width
Enhed: Vercise DBS settings
Deep brain stimulation set at short pulse width and monopolar stimulation using current steering
Eksperimentel: Ventral current steering
Patients with a Vercise DBS system programmed to steer current ventrally
Enhed: Vercise DBS settings
Deep brain stimulation set at short pulse width and monopolar stimulation using current steering
Eksperimentel: Dorsal current steering
Patients with a Vercise DBS system programmed to steer current dorsally.
Enhed: Vercise DBS settings
Deep brain stimulation set at short pulse width and monopolar stimulation using current steering

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Therapeutic Window
Tidsramme: Day 1 programming visit
The therapeutic window refers to the range of stimulus amplitudes that provide a therapeutic effect without side effects. In other words, it is the amplitude difference between the first stimulation-induced side effect threshold (e.g., eye deviation, muscle contraction, and speech) and full rigidity control threshold at 60 µs and 30 µs pulse width DBS settings.
Day 1 programming visit
Unified Parkinson's Disease Rating Scale III
Tidsramme: Day 1 programming visit

The Unified Parkinson's Disease Rating Scale (UPDRS) has four sections (I-IV) that ask patients to rate aspects of their mental state including mood (I), aspects of daily activities (II), aspects of motor function (III), and complications of treatment (IV). Here, we ask subjects to rate their motor function (UPDRS III) following interventions with 30 µs and 60 µs pulse width DBS settings.

The UPDRS III scale has 14 categories including speech, facial expression, tremor at rest, action tremor, rigidity, finger tapping ability, ability to open and close hands, ability to rapidly alternate hand movements, leg agility, ability to rise from a chair, posture, gait, response to postural displacement (e.g., push), and bradykinesia. Patients rate each of these categories from 0 to 4, with 0 being normal function and 4 being the worst. Categories assessing appendages are rated for both left and right sides, allowing a maximum score (worst outcome) of 108.
Day 1 programming visit

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Side Effect Thresholds - Single Contact vs. Steering
Tidsramme: Day 1 programming visit
This endpoint determined how much current (mA) could be applied before side effects appeared when using 60 microsecond pulse widths. Values were obtained for when current was delivered through a single contact or divided between two contacts (steering).
Day 1 programming visit
Resting Tremor Severity - Single Contact vs. Steering
Tidsramme: Day 1 programming visit
Resting tremor was measured by a motion sensor system (Kinesia System) while either using a single contact or steering current between two contacts. Stimulation was at amplitudes defined as the therapeutic threshold for rigidity. The Kinesia System was worn by patients to measure motion parameters including linear acceleration and angular velocity during different tasks, then provided an output score on a scale of 0 (no symptoms) to 4 (severe symptoms).
Day 1 programming visit
Finger Tapping Amplitude - Single Contact vs. Steering
Tidsramme: Day 1 programming visit
Severity of finger-tapping bradykinesia was measured by a motion sensor system (Kinesia System) when either using a single contact or steering current between two contacts. Stimulation was at amplitudes defined as the therapeutic threshold for rigidity. The Kinesia System was worn by patients to measure motion parameters including linear acceleration and angular velocity during different tasks, then provided an output score on a scale of 0 (no symptoms) to 4 (severe symptoms).
Day 1 programming visit

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Dorsal-Ventral Current Steering Therapeutic Window
Tidsramme: Day 1 programming visit
The therapeutic window refers to the range of stimulus amplitudes that provide a therapeutic effect without side effects. In other words, this measure reports the stimulus amplitude difference between the full rigidity control threshold and the first stimulation induced side effect threshold at current steering settings (current divided 50% between adjacent electrodes).
Day 1 programming visit
Resting Tremor Severity - Pulse Width and Dorsal-Ventral Steering
Tidsramme: Day 1 programming Visit
Resting tremor was measured by a motion sensor system (Kinesia System) at 60 µs, 30 µs, and current steering settings, at amplitudes defined as the therapeutic threshold for rigidity. The Kinesia System was worn by patients to measure motion parameters including linear acceleration and angular velocity during different tasks, then provided an output score on a scale of 0 (no symptoms) to 4 (severe symptoms).
Day 1 programming Visit
Finger Tapping Amplitude - Pulse Width and Dorsal-Ventral Steering
Tidsramme: Day 1 programming visit
Severity of finger-tapping bradykinesia was measured by a motion sensor system (Kinesia System) at 60 µs, 30 µs, and dorsal and ventral current steering settings. Stimulation was at amplitudes defined as the therapeutic threshold for rigidity. The Kinesia System was worn by patients to measure motion parameters including linear acceleration and angular velocity during different tasks, then provided an output score on a scale of 0 (no symptoms) to 4 (severe symptoms).
Day 1 programming visit

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Boston Scientific Corporation

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. juni 2013

Primær færdiggørelse (Faktiske)

1. december 2014

Studieafslutning (Faktiske)

1. december 2014

Datoer for studieregistrering

Først indsendt

24. juni 2013

Først indsendt, der opfyldte QC-kriterier

10. juli 2013

Først opslået (Skøn)

11. juli 2013

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

19. november 2020

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

17. november 2020

Sidst verificeret

1. november 2020

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • A4009
  • CDM00060272 (Anden identifikator: BSC Protocol Number)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

Kliniske forsøg med Vercise DBS settings

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Sponsorer og samarbejdspartnere

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Betingelser

Sjældne sygdomme

Narkotikainterventioner

Kosttilskud

Sponsor / samarbejdspartnere

Placeringer

Abonner