Slowing Down Disease Progression in Premanifest SCA: a Piloting Interventional Exergame Trial

Slowing Down Disease Progression in Premanifest SCA: a Piloting Interventional Exergame Trial

This is a piloting study using continuous motor training provided via whole body-controlled video games (exergames) to establish proof-of-concept evidence that such training leads to motor and neural changes in pre-manifest subjects with spinocerebellar ataxias (SCA).

In many neurodegenerative diseases, including spinocerebellar ataxias (SCA), large populations of neurons are already lost and compensatory resources exhausted at time of clinical diagnosis. This calls for early intervention strategies aiming to slow down disease progression already at the premanifest stage of the disease. Here we propose the world-first interventional study aiming to delay onset in a rare genetic neurodegenerative disease. Specifically, we propose a piloting study using continuous motor training provided via whole body-controlled video games (exergames) to establish proof-of-concept evidence that such training leads to motor and neural changes in pre-manifest SCA subjects. The subclinical effects will be unravelled within an intraindividual control study design by elaborated quantitative Video Management System (VICON®)-based movement analysis and structural and functional 3 Tesla (T) magnetic resonance imaging. This will provide unique insights in underlying motor and neural networks and compensatory strategies. If successful, this piloting trial will provide the basis for a rigorous international multi-center large-scale study in a larger SCA population. Moreover, it will stimulate complementary tandem projects on effects of motor training on neural functioning and molecular pathways in premanifest SCA mouse models.

Inclusion Criteria:

• adult persons (age 18-80 years) who (i) are a blood-related relative of an index subject with a known SCA 1,2,3 or 6 mutation and who (ii) have a score value of <8 points on the Scale for the Assessment and Rating of Ataxia (SARA)
• full capacity to consent to study participation after extensive information (fully Informed Consent)

Exclusion Criteria:

• Cognitive deficits which prevent full comprehension of the study requirements and/or training requirements
• Comorbid diseases that place severe constraints on a continous training with whole-body controlled exergames (e.g. severe visual or hearing deficits; severe paresis; severe movement disorders other than ataxia)
• Comorbid neurologic disease other than ataxia (e.g. prior stroke or brain trauma)
• Pregnant or breast-feeding persons
• Lack of capacity for full informed consent according to established psychiatric criteria for full informed consent

Magnetic Resonance Imaging (MRI) exclusion criteria:

• cardiac pacemakers
• artificial heart valves
• metal prostheses
• implanted magnetic metal parts (screws, plates and similar devices)
• intrauterine devices (for instance, for contraceptive purposes)
• shrapnel parts and other metal pieces
• non-removable braces and metal dentures
• non-removable acupuncture needles
• insulin pumps and infusion ports
• tattoos, eye shadow and other metal-containing make-up
• The subject has decreased sensitivity to temperature and / or decreased tolerance towards elevated body temperatures or warming of body parts.