- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT03354455
Investigating the Causal Role of preSMA in Levodopa-induced Dyskinesia in Parkinson's Disease
Targeting the Pre-supplementary Motor Area With Repetitive Transcranial Magnetic Stimulation to Alleviate Levodopa-induced Dyskinesia in Parkinson´s Disease
Using a within-subject cross-over design, we will include 20 patients with Parkinson disease (PD) and peak-of-dose dyskinesia.
Patients will be studied after withdrawal from their normal dopaminergic medication.
On two separate days, each patient will receive off-line, effective (high-intensity) or ineffective (low-intensity) 1 Hz repetitive transcranial magnetic stimulation (rTMS) of the presupplementary motor area (preSMA) before functional magnetic resonance (fMRI). Immediately after the patient will perform a Go/No-Go task during fMRI in the the OFF state for 9 minutes. Then the scan is paused and the patient will receive 200 mg fast-acting oral levodopa and undergo whole-brain task-related fMRI at 3 Tesla until peak-of-dose dyskinesia will emerge.
During task-related fMRI, patients has to click on a mouse with their right hand (Right-Go), left hand (Left-Go), or no action (No-Go) in response to arbitrary visual cues.
The patients will also be tested for different aspects of impulsivity using neuropsychological questionnaires and computerized tests.
Descripción general del estudio
Estado
Intervención / Tratamiento
Descripción detallada
The most common form of levodopa-induced dyskinesias (LID) manifests when levodopa levels are highest and is referred to as peak-of-dose dyskinesia. 50% of patients experience LID after 4-6 years of treatment, reaching a frequency of 40% after 4-6 years. The main risk factors for developing LID are disease duration, levodopa dose and age-at-onset, but none of these factors alone can predict whether and when an individual patient with PD will develop LID. There is converging evidence that exogenously administered levodopa induces non-physiological release and reuptake of dopamine in the striatum. This non-physiological dopaminergic stimulation gives rise to aberrant plasticity in the striatum that causes a sensitization of the cortico-basal ganglia system to levodopa. Dyskinesia often severely affects patients' quality of life requiring advanced treatment.
Adopting a novel pharmacological fMRI (ph-fMRI) approach, our group recently identified a functional signature of LID in the human brain: To bypass any problems due to movement artefacts, fMRI was performed in the time-span between the administration of levodopa and the onset of dyskinesia. Ph-fMRI revealed that a single oral dose of levodopa caused an abnormal cortico-striatal activation and connectivity pattern in pre-SMA and putamen in LID patients relative to PD patients without LID. We predict that 1 Hz rTMS of pre-SMA will attenuate the levo-dopa-induced overactivity in the pre-SMA and putamen and normalise the pre-SMA-putamen connectivity pattern. This may possibly involve an altered interaction with the right inferior frontal gyrus (rIFG).On two separate days, each patient will receive effective (high-intensity) or ineffective (low-intensity) 1 Hz rTMS (i.e. control rTMS session) of the pre-SMA before fMRI (Off-line rTMS).
Pharmacological fMRI (ph-fMRI): Immediately after rTMS the patient will perform a Go/No-Go task during fMRI in the the OFF state for 9 minutes. Then the scan is paused and the patient will receive 200 mg fast-acting oral levodopa and undergo whole-brain task-related fMRI at 3 Tesla until peak-of-dose dyskinesia will emerge. During task-related fMRI, patients press a computer mouse with the right hand (Right-Go), left hand (Left-Go), or no action (No-Go) in response to arbitrary visual cues.
We want to include 20 patients in the final analysis of the study. In a previous comparable study we experienced a drop-out rate around a third. We therefore aim to enrol 30 patients.
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
-
-
Capital Region
-
Hvidovre, Capital Region, Dinamarca, 2650
- Danish Research Centre for Magnetic Resonance
-
-
Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Clinical diagnosis of Parkinson's Disease (Hoehn & Yahr 1-3)
- Peak-of-dose levodopa-induced dyskinesia
Exclusion Criteria:
- Insufficient Danish language skills
- Neurological disease other than Parkinson's Disease
- Major psychiatric illness
- Sedatives or serotonergic medication in their current treatment.
- Severe tremor
- Montreal Cognitive Assessment score < 26
Contraindication for transcranial magnetic stimulation:
- Epilepsy or epilepsy in 1st degree relatives
- Contraindications for MRI-scanning:
- Pacemaker
- Pregnancy
- Metallic foreign objects inside the body
- Severe claustrophobia
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Ciencia básica
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación cruzada
- Enmascaramiento: Único
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
---|---|
Experimental: REAL TMS
30 minutes of repetitive transcranial magnetic stimulation with 100% of the patients' individual resting motor threshold.
|
Frequency: 1 Hz., Pulse shape: biphasic, Duration: 30 minutes (1800 pulses). Neuronavigation: MRI-guided and robot-assisted neuronavigation using Localite software and an Axilum robot. |
Comparador falso: SHAM TMS
30 minutes of repetitive transcranial magnetic stimulation with 30% of the patients' individual resting motor threshold.
|
Frequency: 1 Hz., Pulse shape: biphasic, Duration: 30 minutes (1800 pulses). Neuronavigation: MRI-guided and robot-assisted neuronavigation using Localite software and an Axilum robot. |
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Levodopa-induced change in task-related regional neural activity as indexed by the blood oxygen level dependent (BOLD) signal
Periodo de tiempo: Within the first 60 minutes after levodopa intake
|
A single priming session of REAL rTMS over the preSMA will attenuate the abnormal pharmacodynamic BOLD response (which is an index of regional neural activity) in the cortico-basal ganglia loop after levodopa challenge compared with SHAM rTMS.
|
Within the first 60 minutes after levodopa intake
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
---|---|---|
Onset of LID
Periodo de tiempo: Within the first 60 minutes after levodopa intake
|
A single priming session of REAL rTMS over the SMA will prolong the time to onset of LID compared with SHAM.
|
Within the first 60 minutes after levodopa intake
|
Severity of LID
Periodo de tiempo: Within the first 60 minutes after levodopa intake
|
A single priming session of REAL rTMS over the SMA will lower the the severity of LID measured on the Unified Dyskinesia Rating Scale (UDysRS) compared with SHAM.
|
Within the first 60 minutes after levodopa intake
|
Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Hartwig R Siebner, MD, DMSci, Danish Research Centre for Magnetic Resonance
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
- Trastornos inducidos químicamente
- Enfermedades Cerebrales
- Enfermedades del Sistema Nervioso Central
- Enfermedades del Sistema Nervioso
- Manifestaciones neurológicas
- Trastornos Parkinsonianos
- Enfermedades de los ganglios basales
- Trastornos del movimiento
- Sinucleinopatías
- Enfermedades neurodegenerativas
- Efectos secundarios y reacciones adversas relacionados con los medicamentos
- Envenenamiento
- Síndromes de neurotoxicidad
- Enfermedad de Parkinson
- Discinesias
- Discinesia inducida por fármacos
Otros números de identificación del estudio
- H-15017863
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .
Ensayos clínicos sobre Enfermedad de Parkinson
-
ProgenaBiomeReclutamientoEnfermedad de Parkinson | Enfermedad de Parkinson con demencia | Síndrome de Parkinson-Demencia | Enfermedad de Parkinson 2 | Enfermedad de Parkinson 3 | Enfermedad de Parkinson 4Estados Unidos
-
National Heart, Lung, and Blood Institute (NHLBI)TerminadoEnfermedad de Parkinson 6, inicio temprano | Enfermedad de Parkinson (autosómica recesiva, aparición temprana) 7, humana | Enfermedad de Parkinson Autosómica Recesiva, Inicio Temprano | Enfermedad de Parkinson, autosómica recesiva de aparición temprana, digénica, Pink1/Dj1Estados Unidos
-
Assiut UniversityAún no reclutandoMri en Parkinson
-
Medical College of WisconsinRetirado
-
Hacettepe UniversityTerminadoEnfermedad de Parkinson idiopáticaPavo
-
Pôle Saint HélierRennes University Hospital; Réseau Parkinson BretagneTerminadoEnfermedad de Parkinson | Síndrome de ParkinsonFrancia
-
UCB PharmaTerminadoEnfermedad de Parkinson idiopáticaAlemania
-
Samuel Vilchez, PhDNational Autonomous University of Nicaragua; Wake Forest University; GID BIO, Inc. y otros colaboradoresTerminadoEnfermedad de Parkinson y parkinsonismo | Enfermedad de Parkinson idiopáticaNicaragua
-
AbbVie (prior sponsor, Abbott)Quintiles, Inc.TerminadoEnfermedad de Parkinson avanzadaEstados Unidos, Nueva Zelanda
-
UCB BIOSCIENCES GmbHOtsuka Pharmaceutical Co., Ltd.TerminadoEnfermedad de Parkinson Idiopática AvanzadaCorea, república de, Estados Unidos, Malasia, Singapur, Taiwán
Ensayos clínicos sobre Repetitive transcranial magnetic stimulation
-
University of ArkansasReclutamientoAfasiaEstados Unidos
-
Minneapolis Veterans Affairs Medical CenterCenter for Veterans Research and EducationTerminadoObesidad | Impulsividad | Comer en exceso compulsivamenteEstados Unidos