This is a research study to determine how COBENFY KarXT (FDA approved), a drug which has been approved for treatment of certain disorders, affects brain activity and cognitive tasks which may be regulated by the cholinergic system.
This study aims to answer: 1) how cholinergic circuitries act during task performance in humans, and 2) develop a better understanding of how cognitive control interacts with learning, memory and decision making in the setting of cholinergic manipulation.
Participants will complete a single treatment arm, regardless of which surgical procedure they are to receive. An anesthesiologist or other clinical staff will administer either the drug or the saline at a critical point which addresses the research questions, prior to patient surgery. This will be either with the drug, or the placebo pill. Half of the participants will be randomized to receive the drug, and the other half of these the placebo. Participants will be unaware whether the actual drug has been received.
Essential tremor patients who participate will complete a cognitive task during an awake surgery. Epilepsy patients who participate will have a resting state recording during the procedure from the deep cortical layers of the brain. A probe will be used during the surgery to measure the effects of this drug and other procedures of the study on the cholinergic system. This probe is the clinical probe known as the AlphaOmega, which is FDA approved for standard of care procedures.
Researchers will compare the brain activity between treatment arms to determine what brain activity changes based on the cholinergic manipulation.
Study Population
Inclusion Criteria for Essential Tremor Patients:
Exclusion Criteria for Essential Tremor Patients:
Inclusion Criteria for Epilepsy Patients
Exclusion Criteria for Epilepsy Patients:
Contraindication for cholinergic modulation in both patient sets will be assessed by members of the treatment team (e.g. epileptologist), as well as a neuroanesthesiologist. Multiple medications and conditions are singular disqualifiers; however some medications are eliminated only in combination following neuroanesthesiologist evaluation. Patients at risk of reaction to the treatment arm based on concurrent or recent medications or other health conditions will be excluded from participation.
Inclusion Criteria for Study Participation
Exclusion Criteria for Study Participation
Bradley.Lega@UTSouthwestern.edu214-648-7816
Subjects will receive placebo pill (equivalent of 50/20mg) 2 hours prior to surgery. During awake surgery, the participant will complete either an episodic memory, a spatial memory, a working memory, or a cognitive control task session.
Subjects will receive Cobenfy KarXT pill (50/20 mg) 2 hours prior to surgery. During awake surgery, the participant will complete either an episodic memory, a spatial memory, a working memory, or a cognitive control task session.
Subjects will receive placebo pill (equivalent of 50/20mg) 2 hours prior to surgery. A passive recording with the patient under anesthesia during placebo state will be conducted in order to observe layer-specific baseline firing rate that can be linked with extraoperative ex vivo and in vivo recordings in other contexts.
Subjects will receive Cobenfy KarXT pill (50/20 mg) 2 hours prior to surgery. A passive recording with the patient under anesthesia during cholinergic manipulation will be conducted in order to observe layer-specific changes in firing rate that can be linked with extraoperative ex vivo and in vivo recordings in other contexts.
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