Dystonia Clinical Trial
Official title:
Multicenter, Randomized Trial on the Effects of Pallidal Deep Brain Stimulation for Tardive Dystonia
The purpose of this randomized, double blind, multi-center study is to assess the efficacy and safety of bilateral pallidal deep brain stimulation in patients with tardive dystonia.
Deep brain stimulation (DBS) has been established as a new reversible, neurosurgical
therapeutic option for patients suffering from disabling neurological movement disorders
such as essential tremor and Parkinson´s disease. Recently, deep brain stimulation has been
successfully applied in patients with primary generalized and segmental dystonia.
Additionally, a number of case reports suggest that pallidal deep brain stimulation may also
improve tardive dystonia, which may for instance result from the intake of neuroleptics and
which is notoriously difficult to treat medically. The present study will investigate the
effects of pallidal DBS using a double blind, randomized design (sham- versus
verum-stimulation within a 3-months interval post implantation of the electrodes).
Initially 60 patients had been calculated in a power analysis to assess significant results
based on an average improvement of dystonic symptoms of 30%. However, in a recent study
(Damier et al., Archives of General Psychiatry, 2007), 10 out of 10 showed a successful
outcome of approximately 50% decrease on the extrapyramidal symptoms rating scale score. The
exact one- sided lower 95% confidence limit would be 0.794 for this result. If such an
approach is chosen for sample size estimation with 18 verum and 18 placebo patients one
would obtain a power of 82% against a placebo effect of 30% success rate. For a placebo
effect of 25% one needs 16+16 patients and for the placebo effect of 20% one needs 12+12
patients. We thus decided to reduce the sample size to 36- 32- 24 patients. It is expected
that the continuous primary outcome measure will preserve even higher power than the binary
one used in the study mentioned above. The local ethical committee has approved this.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Outcomes Assessor), Primary Purpose: Treatment
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