Deep Brain Stimulation Neural Recordings of Varied Stimulation During Sleep in Parkinson's Disease (DREAMS-PD)

NeuroTherapia, Inc.

Status: Enrolling

Conditions: Parkinson Disease

Treatments: Other: Nighttime Deep Brain Stimulation with Varying Amplitude Settings

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT07110376

25-323 DREAMS-PD

Details and patient eligibility

About

This study employs an exploratory, prospective, single center, naturalistic clinical trial design with a randomized crossover intervention.

Full description

Deep brain stimulation (DBS) stands as an established and robust treatment for various motor symptoms in patients with Parkinson's disease (PWP). While it has shown promise in ameliorating non-motor symptoms, the mechanisms underlying these improvements remain poorly understood. A significant forthcoming shift in the DBS landscape is the transition towards closed-loop or "adaptive DBS" (aDBS). This approach relies on expanding knowledge of basal ganglia electrophysiology and its correlation with motor symptoms. Augmented beta frequency oscillations (13-35 Hz) in local field potentials (LFP) from the basal ganglia is correlated with severity of the motor systems bradykinesia/rigidity and serve as an electrophysiological biomarker for clinical state. Essentially, aDBS aims to modulate stimulation in response to neural state, offering more precise symptom control.

Sleep disturbances are a prevalent symptom in PWP, affecting a vast majority of patients, and serve as a significant non-motor contributor to quality of life. While DBS has demonstrated benefits in enhancing sleep efficiency and architecture, the mechanisms by which this might occur, as well as the optimal stimulation parameters for treating sleep dysfunctions are unknown. Sleep is associated with a dramatic change in subcortical neural activity compared to the wake state, with decreased beta activity, which could serve as a neurophysiological biomarker for the sleep state. Since beta frequencies are a common target for adaptive DBS studies in PD, addressing sleep-induced reductions in beta activity will be crucial for future algorithm development. Incorrectly interpreting sleep as the "medication-on" state may result in an adaptive algorithm providing the patient with non-optimal stimulation amplitudes that may adversely affect sleep.

There is an urgent need to identify the dose-response curve regarding how stimulation affects sleep quality and neurophysiology. Our primary objective is to address this knowledge gap by obtaining a comprehensive understanding of the subcortical neural signatures of sleep, and their correlation with sleep outcomes under different stimulation currents. This will ultimately enable us to establish the control policy for adaptive control of stimulation amplitude (current). Our central hypothesis is that different stimulation currents will elicit distinct effects on sleep subcortical neural signatures and sleep quality.

Enrollment: 10 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Male or female > 18 years of age
• Diagnosed with idiopathic Parkinson Disease
• Have bilateral implantation of Medtronic's PerceptTM PC (Medtronic Neurological Division, Minneapolis, MN, USA) Deep Brain Stimulation (DBS) system targeting the subthalamic nucleus (STN) and have had their stimulation settings optimized for a minimum of three months
• Report a response score of one or greater on question 1.7 of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part I;
• Demonstrate ability to ambulate independently;
• Be capable of providing informed consent;
• If taking sleep-supporting medications, dosing must be stable for at least 30 days

Exclusion criteria

• Presence of neurological diseases other than Parkinson Disease, such as stroke or multiple sclerosis
• Active sleep disorders, including narcolepsy, moderate to severe (Apnea-Hypopnea Index>=15) untreated sleep apnea, uncontrolled restless legs syndrome
• Cognitive impairment meeting the criteria for dementia as per the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), based on formal neuropsychological evaluation
• Ongoing alcohol or substance abuse; Working night shifts or irregular work hours

The main concern for vulnerable subjects will be for the possibility of reduced decision-making capacity. For this we intend to exclude individuals who have a diagnosis of dementia.

Trial design

Primary purpose: Supportive Care

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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10 participants in 1 patient group

Evaluate the Impact of Deep Brain Stimulation Settings on Sleep

Experimental group

Description:

Participants with Parkinson's disease implanted with a Medtronic Percept™ deep brain stimulation (DBS) system will undergo a 6-week in-home monitoring protocol. Each participant will be exposed to three different nighttime-only DBS stimulation settings in a randomized 2-week crossover design: (1) no stimulation (0% amplitude), (2) reduced stimulation (50% amplitude), and (3) optimal clinical stimulation. Sleep metrics will be collected nightly using the Dreem Headband wearable electroencephalogram (EEG) device. One night of polysomnography will also be conducted to validate the wearable. Subcortical local field potentials (LFPs) from the subthalamic nucleus will be recorded to assess band power and coherence during different stimulation settings and sleep stages. The study aims to evaluate the effect of DBS settings on sleep efficiency, spectral features of neural activity, and their correlation.

Treatment:

Other: Nighttime Deep Brain Stimulation with Varying Amplitude Settings