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The purpose of this research study is to test effectiveness of different deep brain stimulation (DBS) stimulation patterns on symptoms that may also improve the life of the battery. If these patterns are effective, the implanted batteries will be drained more slowly and last longer than currently expected. An increase in battery life may reduce the number of surgeries needed to replace them.
Deep brain stimulation (DBS) is an effective surgical therapy for medication-refractory symptoms of Parkinson's disease, tremor, and dystonia. Patients implanted with DBS experience a significant improvement of their symptoms with relatively low risk of intolerable side effects. Implanted patients must undergo repeat surgeries to replace the Implantable Pulse Generators/batteries (IPG) approximately every 2 to 5 years. The DBS program (at the University of Florida) has studied battery consumption and has been interested in potential strategies to extend the life of the IPG to reduce the need for frequent battery replacement surgeries, while improving symptom-relief, patient satisfaction, and the potential associated financial burdens.
The research study will evaluate the effects of novel stimulation patterns on tremor, bradykinesia, rigidity and gait in Parkinson's disease and essential tremor patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Biphasic DBS stimulations | Subjects in this group will have Biphasic DBS stimulation setting performed, Unified Parkinson's Disease Rating Scale (UPDRS), Tremor Rating Scale (TRS), kinesia accelerometer assessment, Trigno wireless system (EMG) assessment and GaitRite walking assessment performed. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Biphasic DBS stimulation | Device | The following protocol will be followed for each subject. In between, baseline and novel stimulation settings there will be a 30-minute washout period with DBS in the off state.
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| Measure | Description | Time Frame |
|---|---|---|
| Evaluate the efficacy of novel stimulation patterns by the Unified Parkinson's Disease Rating Scale | The Unified Parkinson's Disease Rating Scale (UPDRS) is used by neurologists to rate the motor impairment of people with Parkinson's Disease. The rater obtains the score by observation and questioning the participant. Higher scores represent greater impairment and scores range from 0-108. The subject will be videotaped and two raters blinded to conditions will score the UPDRS. | Baseline to Day 1 |
| Evaluate the efficacy of novel stimulation patterns by the Tremor Rating Scale | Tremor Rating Scale (TRS), consists of 11 items that evaluate tremor in the head, arms, and legs. The rater assigns a score of 0 to 4 for each item, in ascending order of severity. The subjet will be videotaped and two raters blinded to conditions will score the TRS. | Baseline to Day 1 |
| Kinesia accelerometer to measure motor dysfunction | The Kinesia system includes a unit worn by the subject and software that is used to collect, manage, and analyze data. The system measures three-dimensional motion using three orthogonal accelerometers and three orthogonal gyroscopes located in the sensor module.The digital data is received by the Receiver connected to a computer and processed by the Kinesia software package. | Baseline to Day 1 |
| Trigno wireless system to measure motor dysfunction | This system has sensors with a multi-function design and therefore along with recording of surface EMG signal, it allows Triaxial Accelerometry. This wireless EMG machine will measure muscle contractions. | Baseline to Day 1 |
| GaitRite walking assessment. | The GaitRite is an automated floor that when the subjects walk on the floor it records the gait pattern. |
| Measure | Description | Time Frame |
|---|---|---|
| Battery Consumption compared between pre and post settings | Battery consumption will be calculated and compared between the new settings and subjects' baseline settings. The Medtronic battery estimator helpline will be used to calculate battery life, as well as the University of Florida calculator. | Baseline to Day 1 |
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Inclusion Criteria:
Exclusion Criteria:
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Patients will be recruited during routine DBS programming sessions at the University of Florida, Center for Movement Disorders
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| Name | Affiliation | Role |
|---|---|---|
| Micheal Okun, M.D. | University of Florida | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Center for Movement Disorders and Neurorestoration | Gainesville | Florida | 32607 | United States |
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| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| D020329 | Essential Tremor |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| ID | Term |
|---|---|
| D000073216 | Mental Status and Dementia Tests |
| ID | Term |
|---|---|
| D009483 | Neuropsychological Tests |
| D011581 | Psychological Tests |
| D004191 | Behavioral Disciplines and Activities |
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| Unified Parkinson's Disease Rating Scale | Other | UPDRS is used by neurologists to rate the motor impairment of people with Parkinson's Disease. |
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| Tremor Rating Scale | Other | TRS is used by neurologists to rate the severity of a tremor. |
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| Kinesia accelerometer | Device | The kinesia accelerometer is used to analyze the tremor and slowness (bradykinesia) of the participants. |
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| Trigno wireless system | Device | The Trigno system measure muscle contractions. |
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| GaitRite walking assessment. | Other | GaitRite records a patients gait pattern. |
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| Baseline to Day 1 |
| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |