Prader-Willi Syndrome Clinical Trial
Official title:
Proof of Concept Study of Vagus Nerve Stimulation Using an External Device for the Treatment of Behaviour Problems in People With Neurodevelopmental Disorders, Specifically Prader Willi Syndrome
The investigator's recent pilot study of vagus nerve stimulation (VNS) from a surgically
implanted medical device to control the excess eating behaviour characteristic of
Prader-Willi Syndrome (PWS) found that it was safe and acceptable. In addition, there were
unanticipated marked improvements in rates of problem behaviours, such as emotional
disturbances and verbal and physical outbursts. These observations indicated the need for a
trial specifically focusing on the effects of VNS on problem behaviour and also that the use
of VNS might be extended to include people with other neurodevelopmental disorders, such as
autism spectrum conditions (ASC). The primary aims of this study are: a) to investigate
whether VNS, now given by an external medical device, is associated with a significant
reduction in the number and severity of maladaptive behaviours in adults with PWS; and b) to
undertake a pilot study that includes others with a different neurodevelopmental syndrome who
have histories of similar behaviours.
The study will be a single case cross-over design with 4 to 6 months baseline phase and a
similar period of active treatment. The study cannot be blind as the stimulation is apparent
but the participants will wear the device initially for four hours a day, at times convenient
to them, with it switched off in the baseline phase and activated, according to standard
protocols, in the treatment phase. Six adults with PWS and six with a different
neurodevelopmental disorder with histories of significant problem behaviours will be included
initially, with a view to extending if the analysis indicates a likely effect. Behaviours
will be operationally defined and measured over time using participant and informant diaries
with additional secondary outcome measures. Before and during the treatment phases autonomic
nervous system and brain biomarkers will be assessed using ambulatory monitoring of heart
rate variability and fMRI brain scans.
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