Multiple Objective Particle Swarm Optimization Postural Instability Gait Disorder (MOPSO PIGD)

University of Minnesota (UMN)

Status and phase: Enrolling; Early Phase 1

Conditions: Parkinson Disease

Treatments: Other: Deep Brain Stimulation, STN; Other: GP Deep Brain Stimulation

Study type: Interventional

Funder types: Other

Identifiers

NCT05893186

NEUR-2019-28436

Details and patient eligibility

About

Sixty patients will be enrolled in this study who are treated for Parkinson's disease (PD) with bilateral deep brain stimulation of subthalamic nucleus (STN) or globus pallidus (GP), who have a pre- operative 7 Tesla MRI including diffusion tensor imaging for tractography and a postoperative head CT for electrode localization, and in whom at least 3 months have passed since activation of their neurostimulators, for stabilization of clinical stimulator settings. Using their MRI and CT, the investigators will construct patient-specific models of electrical current spread to neuroanatomical tar- gets surrounding the electrode. Then applying nonlinear (particle swarm) optimization, patient- specific stimulator settings will be designed to maximally or minimally activate specific path- ways. In STN DBS: pedunculopallidal vs. pallidopeduncular pathways. In GP DBS: pallidopeduncular pathways at its origin in GP pars interna (GPi) vs. inhibitory afferents to GPi (from GP pars externa GPe). All stimulation falls within the the FDA-approved range for DBS for PD.

Full description

Patients will undergo on-label DBS for the treatment of Parkinson's disease, at stimulator settings different from their usual settings, but within the FDA-approved range for this indication, based on patient specific models that identify stimulation settings that most selectively target one pathway over other adjacent pathways. In Aim 1 (STN DBS), the comparison will be amongst settings that selectively target pedunculopallidal, pallidopeduncular and subthalamopallidal pathways. In Aim 2 (GP DBS), the comparison will be amongst settings which selectively target the pallidopeduncular pathways at its origin in GP pars interna (GPi), inhibitory afferents to GPi (from GP pars externa GPe), and pallidosubthalamic pathway (from GPe). Total time, including both test stimulation and off-stimulation time, will be about 6 hours for Arm 1, and about 5 hours for Arm 2. Testing will include quantitative measures of gait, balance, bradykinesia, and rigidity.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 89 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Diagnosis of PD
• Bilateral DBS
• Directional DBS electrode system
• MRI, at least 7 Tesla, with diffusion tensor imaging, prior to DBS surgery
• Head CT, at least 1mm cuts, following DBS surgery
• At least 3 months since initial activation of the neurostimulator

Exclusion criteria

• Neurological or musculoskeletal disorder that significantly affects gait, balance, or limb movements
• Dementia
• Prior stereotactic neurosurgery other than DBS for movement disorder
• Pregnancy

Trial design

Primary purpose: Basic Science

Allocation: N/A

Interventional model: Parallel Assignment

Masking: Triple Blind

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60 participants in 2 patient groups

STN DBS

Experimental group

Description:

Patients with implanted STN DBS leads will be allocated to this group for DBS stimulation of the STN, within FDA-approved limits and labeling, for symptoms of PD.

Treatment:

Other: Deep Brain Stimulation, STN

GP DBS

Experimental group

Description:

Patients with implanted GP DBS leads will be allocated to this group for DBS stimulation of the GP, within FDA-approved limits and labeling, for symptoms of PD.

Treatment:

Other: GP Deep Brain Stimulation