Antidepressant Effect of Deep Brain Stimulation in Parkinson's Disease Patients - Full Text View

Purpose

The purpose of this study is:

To determine, in the context of a prospective clinical trial, whether stimulation parameters in PD patients treated with DBS, are associated with antidepressant effects.
To determine whether these antidepressant effects are related to or independent of changes in the motor features of PD.
To establish a computerized database that includes stimulation parameters and clinical parameters in PD patients treated with DBS.
To develop a computer-assisted decision making protocol for programming of DBS parameters in both depressed and non-depressed PD patients.

Condition	Intervention
Parkinson's Disease Major Depressive Disorder	Device: DBS parameters setting

Study Type:	Interventional
Study Design:	Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Antidepressant Effect of Deep Brain Stimulation (DBS) in Parkinson's Disease (PD) Patients: Relationship of Stimulation Parameters to Improvement in the Clinical Features of Depression in PD Patients.

Resource links provided by NLM:

Genetics Home Reference related topics: Parkinson disease Perry syndrome

MedlinePlus related topics: Antidepressants Depression Parkinson's Disease

U.S. FDA Resources

Further study details as provided by Hadassah Medical Organization:

Primary Outcome Measures:

The primary outcome measure of the study will be the stimulation parameters of patients who fulfill criteria for MDD at the inception of trial and manifest remission (HAM-D21 score <7) after 4 months (or less) of DBS treatment. [ Time Frame: 18 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Secondary outcome measures will be the relationship between improvement in mental status (as measured by HAM-21, BDI, CGI, HAM-A, BPRS and PDQ39) and change in PD symptoms (as measured by UPDRS). [ Time Frame: 18 months ] [ Designated as safety issue: No ]

Estimated Enrollment:	20
Study Start Date:	May 2009
Study Completion Date:	May 2010
Primary Completion Date:	May 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: 1 PD patient that were treated with STN DBS and developed depression after the surgery (n=5).	Device: DBS parameters setting DBS parameters will be set to increase the DBS affected volume to include both the cognitive and limbic territories in addition to the dorso-lateral motor territories of the STN. This novel approach to parameter selection is directed to achieve improvement in cognitive and limbic as well as motor domains of PD. The patients will therefore be assessed for cognitive, limbic and motor state at multiple time points; there will be a baseline assessment prior to starting treatment (prior to DBS surgery and/or prior to parameters changes); thereafter assessments will follow the stimulation parameter changes; thereafter follow-up assessments at 6 - 12 months. Stimulation parameters will be changed every 2 weeks or earlier if an urgent clinical state emerges. Patients with depression will be monitored for antidepressant effects of stimulation changes. Patients without depression will be monitored for evidence of treatment emergent depression.
Active Comparator: 2 PD patients with depression that are candidates for STN DBS (n=5).	Device: DBS parameters setting DBS parameters will be set to increase the DBS affected volume to include both the cognitive and limbic territories in addition to the dorso-lateral motor territories of the STN. This novel approach to parameter selection is directed to achieve improvement in cognitive and limbic as well as motor domains of PD. The patients will therefore be assessed for cognitive, limbic and motor state at multiple time points; there will be a baseline assessment prior to starting treatment (prior to DBS surgery and/or prior to parameters changes); thereafter assessments will follow the stimulation parameter changes; thereafter follow-up assessments at 6 - 12 months. Stimulation parameters will be changed every 2 weeks or earlier if an urgent clinical state emerges. Patients with depression will be monitored for antidepressant effects of stimulation changes. Patients without depression will be monitored for evidence of treatment emergent depression.
Active Comparator: 3 PD patients without depression that are candidates for STN DBS (n=10).	Device: DBS parameters setting DBS parameters will be set to increase the DBS affected volume to include both the cognitive and limbic territories in addition to the dorso-lateral motor territories of the STN. This novel approach to parameter selection is directed to achieve improvement in cognitive and limbic as well as motor domains of PD. The patients will therefore be assessed for cognitive, limbic and motor state at multiple time points; there will be a baseline assessment prior to starting treatment (prior to DBS surgery and/or prior to parameters changes); thereafter assessments will follow the stimulation parameter changes; thereafter follow-up assessments at 6 - 12 months. Stimulation parameters will be changed every 2 weeks or earlier if an urgent clinical state emerges. Patients with depression will be monitored for antidepressant effects of stimulation changes. Patients without depression will be monitored for evidence of treatment emergent depression.

Detailed Description:

Depressive symptoms of PD patients are major predictors of their prognosis and quality of life. Therefore, successful treatment of depression is crucial in PD patients. Using deep brain stimulation as an antidepressant (or to augment a standard antidepressant) could be a promising new direction. The hypothesis to be tested in the current project is that treatment with deep brain stimulation will improve both the neurological and the psychiatric (depressive) symptoms of PD. It is further hypothesized that the improvement in depressive symptoms will not be a simple consequence of improvement in neurological status. Data from this open label study will form the basis for planning a larger scale controlled trial in depressed PD patients and exploratory studies in patients with major depression who do not have PD.

Today, programming of DBS is based on the neurological evaluation of the motor features of PD. If our hypothesis is proven, i.e. parameter manipulation of DBS affects the mental features of PD, it is crucial to establish a valid database that will enable to study these effects. Moreover, such a detailed database will be the basis for the development of a computer-assisted decision making protocol for programming of DBS. A novel decision making protocol will maximize the benefits of DBS in both depressed and non-depressed PD patients.

Eligibility

Ages Eligible for Study:	40 Years to 75 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Clinically definite PD treated / candidates for treatment with DBS (patients with advanced idiopathic PD who are deemed appropriate for DBS surgery).
Patients will be included in the study irrespective of whether a diagnosis of major depression (mild to moderate but not severe MDD) is fulfilled at baseline. Patients without depression will be monitored in the study for evidence of treatment emergent depression. Patients with depression will be monitored for antidepressant effects of stimulation change.
Age 40-75 years
Male or female.
Competent and willing to give written informed consent.

Exclusion Criteria:

Significant suicidal risk [Hamilton Depression scale item 3 (suicide) >2].
Comorbidity with any Psychotic Disorder, Bipolar Disorder, Post Traumatic Stress Disorder (PTSD), Eating Disorder.
Lifetime history of substance or alcohol dependence or of abuse in the preceding 12 months
Significant cognitive decline, as measured by Addenbrooke's Cognitive Examination (ACE) and the Frontal Assessment Battery (FAB).

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00885222

Locations

Israel
Hadassah Medical Organization
Jerusalem, Israel, 91120

Sponsors and Collaborators

Hadassah Medical Organization

Investigators

Principal Investigator:	Renana Eitan, MD	Hadassah Medical Organization
Study Chair:	Zvi Israel, MD	Hadassah Medical Organization
Study Chair:	Hagai Bergman, MD	Hadassah Medical Organization
Study Chair:	Bernard Lerer, MD	Hadassah Medical Organization

More Information

No publications provided

Responsible Party:	Dr Renana Eitan, MD., Hadassah Medical Organization, Jerusalem, Israel
ClinicalTrials.gov Identifier:	NCT00885222 History of Changes
Other Study ID Numbers:	Eitan-DBS-PD-MDD-HMO-CTIL
Study First Received:	April 20, 2009
Last Updated:	June 2, 2010
Health Authority:	Israel: Ministry of Health

Keywords provided by Hadassah Medical Organization:

Parkinson's disease
Major depressive disorder
Deep brain stimulation

Additional relevant MeSH terms:

Depressive Disorder
Depression
Parkinson Disease
Depressive Disorder, Major
Mood Disorders
Mental Disorders
Behavioral Symptoms
Parkinsonian Disorders
Basal Ganglia Diseases
Brain Diseases

Central Nervous System Diseases
Nervous System Diseases
Movement Disorders
Neurodegenerative Diseases
Antidepressive Agents
Psychotropic Drugs
Central Nervous System Agents
Therapeutic Uses
Pharmacologic Actions

ClinicalTrials.gov processed this record on May 23, 2013