Brain Stimulation for the Treatment of Tourette Syndrome

Tourette Syndrome Clinical Trial

Official title:

Scheduled and Responsive Brain Stimulation for the Treatment of Tourette Syndrome

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01329198
• Other study ID #: 414-2008- A
• Status: Completed
• Phase: N/A
• Start date: September 2009
• Est. completion date: April 2017

Study information

• Verified date: June 2018
• Source: University of Florida
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this trial is to determine whether a particular type of Deep Brain Stimulation (DBS), scheduled Deep Brain stimulation (SBS), is an effective and safe treatment for Tourettte syndrome (TS).

The trial will also examine the brain activity associated with TS and tics and explore the possibility of responsive brain stimulation (RBS).

Description:

DBS is a surgical procedure that seeks to change the brain's electrical signalling by means of applied electrical current. To this end, a wire with tiny stimulating electrodes is implanted into one or both sides of the brain. An electrode is a small piece of metal used to take an electric current to or from a power source. These electrodes are connected under the skin on the scalp to a small electrical unit called an INS (implantable neurostimulator), which is similar to a heart pacemaker. The device sends out electrical impulses that appear to change the normal flow of electricity in the brain.

The wires which house the electrodes will be implanted on both sides of the brain oriented towards the centromedian thalamus-parafascicular complex. This region of the brain has to date the greats number of documented cases revealing significant improvements in motor tics.

This region of the brain will also provide a target where physiological changes related to motor tics are likely to be discovered.

The device we propose for this study has several features that make it more suitable for use in the TS population than other devices. It is self-contained in the skull and brain, and contains no tunneled neck connector wire and no chest pacemaker deice. This will help to lessen infection, and will assist in limiting device-related fractures due to tics involving neck region. Also, the system can record electro-encephalograph data from the area of the electrodes, which will assist us in gathering information about what specific physiological changes are correlated with tics.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 5
• Est. completion date: April 2017
• Est. primary completion date: November 2011
• Accepts healthy volunteers: No
• Gender: All
• Age group: 25 Years and older

Eligibility

Inclusion Criteria:

• diagnosis of TS must be made by both a neurologist and a psychiatrist and must meet standardized criteria

• must have a minimum score on the primary tic rating scale

• symptoms must be causing significant impairment in functioning, making it impossible or almost impossible to do daily activities, including work or school and interactions with friends and family, causing severe distress and a poor quality of life

• symptoms have not responded well enough to medications prescribed by a neurologist or psychiatrist experienced in treating TS. Must have had trials of drugs from three different classes of drugs that have not worked.

• must have received stable and effective treatment of any other existing medical or psychological problems for the past 6 months.

• current TS related-medication(s) must be stable for at least a month without a dose change prior to surgery and must be willing to keep these medications stable and unchanged throughout the study or must be off of TS-related medications for at least three months prior to surgery

• If tics involve only one group of muscles or might be controllable by botulinum toxin treatment, must try botulinum treatment before considering surgery.

• must have a negative urine drug screen

• must give informed consent

Exclusion Criteria:

• have a simple motor tic or movement disorder other than TS, or medication-related movement disorders from TS medications

• have had any previous brain surgery including deep brain stimulation, ablative capsulotomy or cingulotomy

• have another psychiatric condition (including body dysmorphic disorder, a delusional disorder or a biological brain disorder), dementia or cognitive dysfunction that would place subject at risk for worsening cognition and/or may impact ability to comply with study procedures. Also included is any other psychiatric disorder that requires medications or treatments that would interfere with the functioning of the DBS device.

• have any significant substance abuse or dependence (e.g., stimulants, alcohol, opiates, benzodiazepines) within the past six months

• have a severe medical disease including cardiovascular disorder, lung disorder, kidney disease, chronic neurological disease, hematological disease, or frailty that impacts tolerability of the surgery as judged by the screening physicians

• pre-surgery MRI is considered abnormal. You may also be excluded if your brain is considered very small.

• have a history of serious suicidal behavior, are unable to control suicide attempts, or are currently at risk of suicide, in the judgement of the investigator

• have head-banging tics or tics that have the potential to damage the RNS System

• are currently pregnant or breast-feeding, plan to become pregnant during the study, or are not using effective contraception

• are currently enrolled in another investigational study

• have an implant such as a pacemaker or neurostimulator containing electrical circuitry or that generates electrical signals

• have any metal orthopedic pins or plates, metal orthodontics, or non-removable body jewelry

• require diathermy treatments during physical or occupational therapy

• have a problem that will require repeat Magnetic Resonance Imaging (MRI) scans

Related Conditions & MeSH terms

• Syndrome
• Tourette Syndrome

Intervention

Device:
• NeuroPace RNS® System Deep Brain Stimulator
Utilizes a signal that the device detects and will respond to with an electrical pre-defined pulse if the signal is encountered.

Locations

Country	Name	City	State
United States	University of Florida Movement Disorders Center	Gainesville	Florida

Sponsors (1)

Lead Sponsor	Collaborator
University of Florida

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Mean Change in Yale Global Tic Severity Scale (YGTSS) Scores From Baseline to 6 Months Across All Study Participants Presented	The Yale Global Tic Severity Scale (YGTSS) is a semistructured clinician-rated instrument that assesses the severity and frequency of motor and phonic tics over the previous week. Five index scores are obtained during the assessment, where higher scores indicate greater frequency or severity. These indices are: Total Motor Tic Score (0-25); Total Phonic Tic Score (0-25; Total Tic Score (0-50); Overall Impairment Rating (0-50); Global Severity Score (0-7); The YGTSS Total Score is obtained by adding the Total Tic Score to the Overall Impairment Rating. The efficacy of the intervention will be assessed by comparing each subject's 6-month YGTSS Total Score to the pre-operative value for the same patient. Efficacy is considered 50% or greater reduction in this score.	Baseline to 6 Months
Secondary	Correlation of Tics and Neural Physiology	Electrical recordings of electroencephalography activity were taken from each subject's implanted leads at each visit from baseline to 6 months. At baseline, the recordings were taken with the device in the off state (not stimulating), while at the 6 month visits the recordings were taken with the subject's device set to optimal parameters for tic control. Using Pearson's correlation coefficient, the variations in frequency and power which were observed were correlated with the Yale Global Tic Severity (YGTSS) scores obtained during primary outcome testing.	Baseline to 6 Months

External Links

•   A Trial of Scheduled Deep Brain Stimulation for Tourette Syndrome
•   Increased Thalamic Gamma Band Activity Correlates with Symptom Relief following Deep Brain Stimulation in Humans with Tourette's Syndrome