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| ID | Type | Description | Link |
|---|---|---|---|
| 1363 | Other Identifier | Clinical Research Center | |
| G050016 | Other Identifier | FDA IDE |
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Bilateral subthalamic nucleus deep brain stimulation (B-STN DBS) is one of the most effective surgical treatments for PD patients suffering from levodopa-induced motor complications. The relatively low incidence of permanent adverse effects and the potential for neuroprotection and alteration of the natural course of PD suggest a highly favorable benefit-to-risk ratio of this procedure. Since neuroprotection is best applied early in the disease course when there are more surviving neurons, we believe that further investigation of this procedure is warranted. The proposed pilot study will provide the necessary data to substantiate the safety and tolerability of the procedure as well as provide data for the design of a full-scale, multicenter trial to investigate the hypothesis that B-STN DBS is a safe and effective treatment to slow the progression of PD.
This pilot trial is designed specifically to collect the preliminary safety and tolerability data necessary to conduct a future phase III clinical trial to investigate the hypothesis that deep brain stimulation of the subthalamic nucleus in subjects with early Parkinson's will slow the progression of the disease.
The study design is a prospective, randomized, blinded, single-center trial comparing the safety and tolerability of B-STN DBS + Optimal Drug Therapy (ODT) vs. (ODT) alone (control, standard of care) in 30 subjects (15 per group) with early PD (Hoehn and Yahr stage II when off medication).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ODT | Active Comparator | Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. |
|
| DBS+ODT | Experimental | Subjects receive bilateral subthalamic nucleus (B-STN) DBS and continue to take optimal drug therapy as prescribed by their treating neurologist. B-STN DBS: Deep brain stimulation (DBS) of both the right and left sub-thalamic nucleus (STN) is an FDA approved treatment for mid- and advanced PD. DBS is not approved for early stage PD. In mid- and advanced stage Parkinson's disease, using DBS in this area of the brain lessens symptoms and allows patients to take less drug to control the disease. Dosage and frequency are not applicable to the DBS. Once the DBS is placed, unless deemed necessary, it will not be removed. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| B-STN DBS | Device | Deep brain stimulation (DBS) of both the right and left sub-thalamic nucleus (STN) is an FDA approved treatment for advanced PD. In mid- and advanced stage Parkinson's disease, using DBS in this area of the brain lessens symptoms and allows patients to take less drug to control the disease. Dosage and frequency are not applicable to the DBS. Once the DBS is placed, unless deemed necessary, it will not be removed. |
| Measure | Description | Time Frame |
|---|---|---|
| Safety: Time to Reach a 4 Point Increase (Worsening) in Unified Parkinson's Disease Rating Scale (UPDRS) Motor Score | The primary hypothesis of this feasibility trial was focused on safety and tolerability and that the DBS+ODT group would not worsen more quickly than the ODT group. | baseline to 24 months |
| Levodopa Equivalents, Change From Baseline | 100 mg of levodopa with a dopa-decarboxylase inhibitor = 133 mg of controlled-release levodopa preparations = total levodopa dose + (total levodopa dose x 0.33) of levodopa with dopa-decarboxylase and entacapone = 1 mg of pergolide, pramipexole, or lisuride = 5 mg of ropinirole = 3.3 mg of rotigotine | baseline to 24 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in UPDRS Part I, Mentation Behavior and Mood | Score: 0-16 0 =normal, 16 = most disability | baseline to 24 months |
| Change in UPDRS Part II, Activities of Daily Living | Score: 0-52 0 =normal, 52 = most limited |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| P. David Charles, MD | Vanderbilt University Department of Neurology | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36567243 | Derived | Hacker ML, Meystedt JC, Turchan M, Cannard KR, Harper K, Fan R, Ye F, Davis TL, Konrad PE, Charles D. Eleven-Year Outcomes of Deep Brain Stimulation in Early-Stage Parkinson Disease. Neuromodulation. 2023 Feb;26(2):451-458. doi: 10.1016/j.neurom.2022.10.051. Epub 2022 Dec 24. | |
| 32601120 | Derived | Hacker ML, Turchan M, Heusinkveld LE, Currie AD, Millan SH, Molinari AL, Konrad PE, Davis TL, Phibbs FT, Hedera P, Cannard KR, Wang L, Charles D. Deep brain stimulation in early-stage Parkinson disease: Five-year outcomes. Neurology. 2020 Jul 28;95(4):e393-e401. doi: 10.1212/WNL.0000000000009946. Epub 2020 Jun 29. |
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7 participants excluded prior to treatment ( 1 withdrew consent and 6 failed screening)
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| ID | Title | Description |
|---|---|---|
| FG000 | Optimal Drug Therapy (ODT) | Patients receive optimal drug therapy as prescribed by their treating neurologist. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. Examples of drugs used include carbidopa/levodopa, pramipexole, ropinirole, and selegiline. |
| FG001 | Deep Brain Stimulation (DBS) Plus Optimal Drug Therapy (ODT) | Subjects receive bilateral subthalamic nucleus (B-STN) DBS and continue to take optimal drug therapy as prescribed by their treating neurologist. B-STN DBS: Deep brain stimulation (DBS) of both the right and left sub-thalamic nucleus (STN) is an FDA approved treatment for mid- and advanced PD. DBS is not approved for early stage PD. In mid- and advanced stage Parkinson's disease, using DBS in this area of the brain lessens symptoms and allows patients to take less drug to control the disease. Dosage and frequency are not applicable to the DBS. Once the DBS is placed, unless deemed necessary, it will not be removed. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. Examples of drugs |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Optimal Drug Therapy (ODT) | Patients receive optimal drug therapy as prescribed by their treating neurologist. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. Examples of drugs used include carbidopa/levodopa, pramipexole, ropinirole, and selegiline. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Safety: Time to Reach a 4 Point Increase (Worsening) in Unified Parkinson's Disease Rating Scale (UPDRS) Motor Score | The primary hypothesis of this feasibility trial was focused on safety and tolerability and that the DBS+ODT group would not worsen more quickly than the ODT group. | all 29 subjects that completed at least one follow up visit were included in the primary analysis following intent to treat principle | Posted | Mean | 95% Confidence Interval | months | baseline to 24 months |
|
baseline to 24 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Optimal Drug Therapy (ODT) | Patients receive optimal drug therapy as prescribed by their treating neurologist. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. Examples of drugs used include carbidopa/levodopa, pramipexole, ropinirole, and selegiline. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Perioperative infarction in left basil ganglia | Nervous system disorders | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Insomnia | Nervous system disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| David Charles, MD | Vanderbilt University Medical Center | david.charles@Vanderbilt.Edu |
| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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|
| Optimal drug therapy | Drug | The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. Examples of drugs used include carbidopa/levodopa, pramipexole, ropinirole, and selegiline. |
|
| baseline to 24 months |
| Change in UPDRS Part III, Motor Examination, Excluding Rigidity | Score: 0-56 0 = full movement, 56 = most limited | baseline to 24 months |
| Change in UPDRS Part IV, Complications of Therapy | Score: 0-23 0 =no complications, 23 = most complications | baseline to 24 months |
| Change in Total UPDRS | The Total Unified Parkinson's Disease Rating Scale (UPDRS) is a composite scale, consisting of four sections that evaluate mood and behavior, activities of daily living, motor symptoms, and complications of medical therapy. Range is 0 to 16, with 16 being maximal disability | baseline to 24 months |
| 28676842 | Derived | Millan SH, Hacker ML, Turchan M, Molinari AL, Currie AD, Charles D. Subthalamic Nucleus Deep Brain Stimulation in Early Stage Parkinson's Disease Is Not Associated with Increased Body Mass Index. Parkinsons Dis. 2017;2017:7163801. doi: 10.1155/2017/7163801. Epub 2017 Jun 6. |
| 22104012 | Derived | Charles PD, Dolhun RM, Gill CE, Davis TL, Bliton MJ, Tramontana MG, Salomon RM, Wang L, Hedera P, Phibbs FT, Neimat JS, Konrad PE. Deep brain stimulation in early Parkinson's disease: enrollment experience from a pilot trial. Parkinsonism Relat Disord. 2012 Mar;18(3):268-73. doi: 10.1016/j.parkreldis.2011.11.001. Epub 2011 Nov 21. |
| BG001 | Deep Brain Stimulation (DBS) Plus Optimal Drug Therapy (ODT) | Subjects receive bilateral subthalamic nucleus (B-STN) DBS and continue to take optimal drug therapy as prescribed by their treating neurologist. B-STN DBS: Deep brain stimulation (DBS) of both the right and left sub-thalamic nucleus (STN) is an FDA approved treatment for mid- and advanced PD. DBS is not approved for early stage PD. In mid- and advanced stage Parkinson's disease, using DBS in this area of the brain lessens symptoms and allows patients to take less drug to control the disease. Dosage and frequency are not applicable to the DBS. Once the DBS is placed, unless deemed necessary, it will not be removed. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. Examples of drugs |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| OG001 | Deep Brain Stimulation (DBS) Plus Optimal Drug Therapy (ODT) | Subjects receive bilateral subthalamic nucleus (B-STN) DBS and continue to take optimal drug therapy as prescribed by their treating neurologist. B-STN DBS: Deep brain stimulation (DBS) of both the right and left sub-thalamic nucleus (STN) is an FDA approved treatment for mid- and advanced PD. DBS is not approved for early stage PD. In mid- and advanced stage Parkinson's disease, using DBS in this area of the brain lessens symptoms and allows patients to take less drug to control the disease. Dosage and frequency are not applicable to the DBS. Once the DBS is placed, unless deemed necessary, it will not be removed. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. |
|
|
|
| Primary | Levodopa Equivalents, Change From Baseline | 100 mg of levodopa with a dopa-decarboxylase inhibitor = 133 mg of controlled-release levodopa preparations = total levodopa dose + (total levodopa dose x 0.33) of levodopa with dopa-decarboxylase and entacapone = 1 mg of pergolide, pramipexole, or lisuride = 5 mg of ropinirole = 3.3 mg of rotigotine | Posted | Mean | 95% Confidence Interval | mg | baseline to 24 months |
|
|
|
|
| Secondary | Change in UPDRS Part I, Mentation Behavior and Mood | Score: 0-16 0 =normal, 16 = most disability | Posted | Mean | 95% Confidence Interval | units on a scale | baseline to 24 months |
|
|
|
| Secondary | Change in UPDRS Part II, Activities of Daily Living | Score: 0-52 0 =normal, 52 = most limited | Posted | Mean | 95% Confidence Interval | units on a scale | baseline to 24 months |
|
|
|
| Secondary | Change in UPDRS Part III, Motor Examination, Excluding Rigidity | Score: 0-56 0 = full movement, 56 = most limited | Posted | Mean | 95% Confidence Interval | change in units on a scale | baseline to 24 months |
|
|
|
| Secondary | Change in UPDRS Part IV, Complications of Therapy | Score: 0-23 0 =no complications, 23 = most complications | Posted | Mean | 95% Confidence Interval | units on a scale | baseline to 24 months |
|
|
|
| Secondary | Change in Total UPDRS | The Total Unified Parkinson's Disease Rating Scale (UPDRS) is a composite scale, consisting of four sections that evaluate mood and behavior, activities of daily living, motor symptoms, and complications of medical therapy. Range is 0 to 16, with 16 being maximal disability | Posted | Mean | 95% Confidence Interval | units on a scale | baseline to 24 months |
|
|
|
| 0 |
| 14 |
| 0 |
| 14 |
| 15 |
| 15 |
| EG001 | Deep Brain Stimulation (DBS) Plus Optimal Drug Therapy (ODT) | Subjects receive B-STN DBS and continue to take optimal drug therapy as prescribed by their treating neurologist. B-STN DBS: Deep brain stimulation (DBS) of both the right and left sub-thalamic nucleus (STN) is an FDA approved treatment for advanced PD. DBS is not approved for early stage PD. The STN is a part of the brain that is very small in size and is located in the middle of the right and left sides of the brain. In this disease, this part of the brain becomes overactive and causes the symptoms of PD. It is thought that using DBS in this area of the brain lessens symptoms and allows patients to take less drug to control the disease. Dosage and frequency are not applicable to the DBS. Once the DBS is placed, unless deemed necessary, it will not be removed. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinson's disease that are standard of care. The drug form, dosage, frequency and duration will vary. Examples of drugs | 0 | 15 | 2 | 15 | 15 | 15 |
| Infection | Infections and infestations | Systematic Assessment | Developed due to injury at subject's home. |
|
| Nausea | Gastrointestinal disorders | Systematic Assessment |
|
| Nasopharyngitis | Immune system disorders | Systematic Assessment |
|
| Weight decreased | General disorders | Systematic Assessment |
|
| Dizziness | Nervous system disorders | Systematic Assessment |
|
| Dyspnoea | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Weight increased | General disorders | Systematic Assessment |
|
| Vomiting | Gastrointestinal disorders | Systematic Assessment |
|
| Dysphagia | Gastrointestinal disorders | Systematic Assessment |
|
| Fatigue | General disorders | Systematic Assessment |
|
| Neck pain | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Headache | Nervous system disorders | Systematic Assessment |
|
| Constipation | Gastrointestinal disorders | Systematic Assessment |
|
| Bronchitis | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Memory impairment | Nervous system disorders | Systematic Assessment |
|
| Musculoskeletal pain | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Chest pain | Cardiac disorders | Systematic Assessment |
|
| Diarrhoea | Gastrointestinal disorders | Systematic Assessment |
|
| Urinary tract infection | Infections and infestations | Systematic Assessment |
|
| Back pain | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Hallucination | Nervous system disorders | Systematic Assessment |
|
| Pain in extremity | Nervous system disorders | Systematic Assessment |
|
| Somnolence | Nervous system disorders | Systematic Assessment |
|
| Presyncope | Nervous system disorders | Systematic Assessment |
|
| Arthralgia | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Decreased appetite | General disorders | Systematic Assessment |
|
| Depression | Psychiatric disorders | Systematic Assessment |
|
| Abnormal touch sensation | Nervous system disorders | Systematic Assessment |
|
| Implant site pain | Surgical and medical procedures | Systematic Assessment |
|
| Aphasia | Nervous system disorders | Systematic Assessment |
|
| Diplopia | Eye disorders | Systematic Assessment |
|
| Erectile dysfunction | Reproductive system and breast disorders | Systematic Assessment |
|
| Haematuria | Renal and urinary disorders | Systematic Assessment |
|
| Hot flush | General disorders | Systematic Assessment |
|
| Upper-airway cough syndrome | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Vision blurred | Nervous system disorders | Systematic Assessment |
|
| Oropharyngeal pain | Gastrointestinal disorders | Systematic Assessment |
|
| Agitation | Nervous system disorders | Systematic Assessment |
|
| Cough | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Hiatus hernia | Gastrointestinal disorders | Systematic Assessment |
|
| Incision site pain | Surgical and medical procedures | Systematic Assessment |
|
| Joint swelling | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Nephrolithiasis | Renal and urinary disorders | Systematic Assessment |
|
| Pain | General disorders | Systematic Assessment |
|
| Rib fracture | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Abdominal distension | Gastrointestinal disorders | Systematic Assessment |
|
| Confusional state | Nervous system disorders | Systematic Assessment |
|
| Influenza | Infections and infestations | Systematic Assessment |
|
| Micturition urgency | Renal and urinary disorders | Systematic Assessment |
|
| Myalgia | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Restlessness | General disorders | Systematic Assessment |
|
| Sleep apnoea syndrome | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Abnormal dreams | Nervous system disorders | Systematic Assessment |
|
| Allergic rhinitis | Immune system disorders | Systematic Assessment |
|
| Asthenia | Nervous system disorders | Systematic Assessment |
|
| Blood pressure fluctuation | Cardiac disorders | Systematic Assessment |
|
| Carpal tunnel syndrome | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Cognitive disorder | Nervous system disorders | Systematic Assessment |
|
| Coronary artery disease | Cardiac disorders | Systematic Assessment |
|
| Dysphonia | General disorders | Systematic Assessment |
|
| Excoriation | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Gastric ulcers | Gastrointestinal disorders | Systematic Assessment |
|
| Gastrointestinal oedema | Gastrointestinal disorders | Systematic Assessment |
|
| Hepatic cirrhosis | Hepatobiliary disorders | Systematic Assessment |
|
| Hydronephrosis | Renal and urinary disorders | Systematic Assessment |
|
| Hypersensitivity | Nervous system disorders | Systematic Assessment |
|
| Hypoaesthesia | Nervous system disorders | Systematic Assessment |
|
| Hypotension | Cardiac disorders | Systematic Assessment |
|
| Hypothyroidism | Endocrine disorders | Systematic Assessment |
|
| Incision site erythema | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Increased appetite | General disorders | Systematic Assessment |
|
| Influenza like illness | Infections and infestations | Systematic Assessment |
|
| Inguinal hernia | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Kidney enlargement | Renal and urinary disorders | Systematic Assessment |
|
| Libido decreased | Reproductive system and breast disorders | Systematic Assessment |
|
| Limb injury | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Musculoskeletal stiffness | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Osteoarthritis | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Peripheral oedema | General disorders | Systematic Assessment |
|
| Plantar erythema | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Pneumonia | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Pollakiuria | Renal and urinary disorders | Systematic Assessment |
|
| Prostate cancer | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | Systematic Assessment |
|
| Rash papular | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Syncope | Nervous system disorders | Systematic Assessment |
|
| Thyroid cancer | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | Systematic Assessment |
|
| Toothache | General disorders | Systematic Assessment |
|
| Troponin increased | Cardiac disorders | Systematic Assessment |
|
| Urine output decreased | Renal and urinary disorders | Systematic Assessment |
|
| Anxiety | Psychiatric disorders | Systematic Assessment |
|
| Contusion | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Deafness | Ear and labyrinth disorders | Systematic Assessment |
|
| Decreased interest | Nervous system disorders | Systematic Assessment |
|
| Drooling | Nervous system disorders | Systematic Assessment |
|
| Dyspepsia | Gastrointestinal disorders | Systematic Assessment |
|
| Dysuria | Renal and urinary disorders | Systematic Assessment |
|
| Early satiety | Gastrointestinal disorders | Systematic Assessment |
|
| Eye infection | Infections and infestations | Systematic Assessment |
|
| Gastroenteritis viral | Gastrointestinal disorders | Systematic Assessment |
|
| Haematochezia | Gastrointestinal disorders | Systematic Assessment |
|
| Hallucination, auditory | Nervous system disorders | Systematic Assessment |
|
| Hand fracture | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Hepatic steatosis | Gastrointestinal disorders | Systematic Assessment |
|
| Hyperhidrosis | Nervous system disorders | Systematic Assessment |
|
| Infection - Other (DBS lead) | Surgical and medical procedures | Systematic Assessment |
|
| Joint range of motion decreased | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Laceration | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Mood altered | Nervous system disorders | Systematic Assessment |
|
| Muscle tightness | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Muscular weakness | General disorders | Systematic Assessment |
|
| Neurophathy peripheral | Nervous system disorders | Systematic Assessment |
|
| Nightmare | Nervous system disorders | Systematic Assessment |
|
| Pernicious anaemia | Blood and lymphatic system disorders | Systematic Assessment |
|
| Pseudomeningocele | Nervous system disorders | Systematic Assessment |
|
| Psychomotor hyperactivity | Nervous system disorders | Systematic Assessment |
|
| Pyrexia | Infections and infestations | Systematic Assessment |
|
| Restless legs syndrome | Nervous system disorders | Systematic Assessment |
|
| Rhinitis allergic | Immune system disorders | Systematic Assessment |
|
| Sensation of heaviness | Nervous system disorders | Systematic Assessment |
|
| Sinus congestion | Immune system disorders | Systematic Assessment |
|
| Sinusitis | Infections and infestations | Systematic Assessment |
|
| Spinal osteoarthritis | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Spondylolisthesis | Musculoskeletal and connective tissue disorders | Systematic Assessment |
|
| Testicular pain | Reproductive system and breast disorders | Systematic Assessment |
|
| Thermal burn | Injury, poisoning and procedural complications | Systematic Assessment |
|
| Tracheobronchitis | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Urinary incontinence | Renal and urinary disorders | Systematic Assessment |
|
| Vertigo | Nervous system disorders | Systematic Assessment |
|
Not provided
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| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |