Superior Colliculus Activity in Parkinson Disease: a Potential Marker? (AGIRPARK)

• ClinicalTrials.gov Identifier: NCT02488395
• Recruitment Status: Completed
• First Posted: July 2, 2015
• Last Update Posted: August 26, 2021
• Sponsor: Institut National de la Santé Et de la Recherche Médicale, France
• Information provided by (Responsible Party): Institut National de la Santé Et de la Recherche Médicale, France

Tracking Information

• First Submitted Date: June 26, 2015
• First Posted Date: July 2, 2015
• Last Update Posted Date: August 26, 2021
• Actual Study Start Date: October 7, 2015
• Actual Primary Completion Date: January 2018 (Final data collection date for primary outcome measure)
• Current Primary Outcome Measures (submitted: June 30, 2015): Light responses measure in the superior colliculus [ Time Frame: 2 hours / session ]
• Original Primary Outcome Measures: Same as current
• Current Secondary Outcome Measures: Not Provided
• Original Secondary Outcome Measures: Not Provided
• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: Superior Colliculus Activity in Parkinson Disease: a Potential Marker?
• Official Title: Superior Colliculus Activity in Parkinson Disease: a Potential Marker? fMRI Brain Activation in Response to Visual Stimuli.

Brief Summary

The ultimate goal of this project is to evaluate a possible new strategy to diagnose earlier Parkinson's disease, using the superior colliculus as a biomarker.

Preliminary data from the investigator's group in a rat model of Parkinson's disease suggest that the superior colliculus, a sensory structure, show an early deficit in visual processing. The investigator's data also suggests that with the evolution of the disease, this structure presents a neuronal re-organisation leading which causes a sensory rebound after the introduction of the treatment. The light responses in the superior colliculus were faster, bigger in amplitude and lasted longer (Rolland et al., 2012). Those results raise an important question about the superior colliculus functional state in Parkinson's patients. If this structure have a similar neuroplasticity, the investigators could hypothesize that the superior colliculus may also present a sensory rebound when introducing the treatment. If this hypothesis is true, the accelerated and amplified light responses of this structure may explain the difficulties felt by the patients to inhibit reflexive saccades induced by the appearance of unexpected visual stimuli. Indeed, the superior colliculus is involved in the orientation of the head and eye toward any sudden changes in our environment (Wurtz and Albano, 1980) and the light responses of this structure are strongly correlated with the speed of the saccade (Marino et al., 2012).

Therefore, the investigators want to test if a similar deficit could be observed in the superior colliculus of newly diagnosed PD patients. Data will be compared to matching controls.

Detailed Description

This project aims at better understanding the physiopathology of Parkinson's disease and the effect of the administration of the classical medical treatment. The main aim of this project is to evaluate the possibility of an early detection using a new original strategy. The investigators want to demonstrate the predictive value of the superior colliculus light responses as an early biomarker.

The investigators will perform functional magnetic resonance imagery (fMRI) to measure the BOLD light responses of the superior colliculus at different key stages of the normal medical follow up of Parkinson's patients by the neurologist (when diagnosed, when introducing the first treatment and when the treatment is stabilised).

Two groups of participants will be tested: a) a group of de novo patients, which have just been diagnosed and haven't started their treatment; b) a group of matching controls.

A first fMRI session (S1) will be performed to compare the light induced BOLD response of the superior colliculus between de novo patients and their matching controls. This session will evaluate a possible visual processing dysfunction in the superior colliculus of newly diagnosed patients.

Parkinson's patients will then start their treatment and a second session (S2) will be done on this group shortly after the introduction of the treatment to measure its acute effect. If the superior colliculus of those patients presents a sensory rebound, the investigators should observe a bigger light-induced BOLD response after the treatment compared to before the treatment.

A third session (S3) will be performed after the optimal adjustment of the treatment on motor symptoms which would be around six month after the start of the treatment. This adjustment is long and difficult, realized by the neurologist according to its effect on the motor symptoms. Those two last fMRI will allow the investigators to compare the effect of the introduction of the treatment on the motor symptoms, known to not improve correctly at this stage, and on non-motor symptoms (visual processing deficits in this project) from which no information are available to the investigators knowledge.

• Study Type: Observational
• Study Design: Observational Model: Case-Control; Time Perspective: Prospective
• Target Follow-Up Duration: Not Provided
• Biospecimen: Not Provided
• Sampling Method: Probability Sample
• Study Population: Groups of de novo Parkinson's patients and their age matching controls.
• Condition: Parkinson's Disease

Intervention

• Other: fMRI
  The investigators will use a non invasive fMRI technique centred on the superior colliculus during the presentation of flickered check-boards with varying contrast (1, 3, 5 and 9 %).
• Other: Ophthalmologic evaluation
  The aim of this experiment is the evaluate the functional state of a visual structure. Therefore, with this ophthalmologic test, the investigators will control if the participant does not present major visual deficits. This examination will evaluate the visual acuity and the visual field. A funduscopic examination will also be performed to check the retina.
• Other: visual psychophysics test
  This test will allow to control the sensitivity of the participant to our contrast. The participant will be asked to look at screen on which three static check-boards will be presented. The participant will have to choose the two check-boards with the closest contrast.

Study Groups/Cohorts

• de novo Parkinson's patients

  This group includes de novo Parkinson's patients who have just been diagnosed and not started their treatment at the inclusion.

  This group will perform three fMRI sessions at different crucial steps of their normal follow up with a neurologist. Their visual abilities will be tested with an ophthalmologic evaluation and their sensitivity to contrast with a visual psycho-physics test.

  Interventions:

  • Other: fMRI
  • Other: Ophthalmologic evaluation
  • Other: visual psychophysics test
• matching controls

  This group includes age-matching control participants to the first Parkinson group.

  This group will perform one fMRI session. Their visual abilities will be tested with an ophthalmologic evaluation and their sensitivity to contrast with a visual psycho-physics test.

  Interventions:

  • Other: fMRI
  • Other: Ophthalmologic evaluation
  • Other: visual psychophysics test

Publications *

• Marino RA, Levy R, Boehnke S, White BJ, Itti L, Munoz DP. Linking visual response properties in the superior colliculus to saccade behavior. Eur J Neurosci. 2012 Jun;35(11):1738-52. doi: 10.1111/j.1460-9568.2012.08079.x. Epub 2012 May 28.
• Wurtz RH, Albano JE. Visual-motor function of the primate superior colliculus. Annu Rev Neurosci. 1980;3:189-226. doi: 10.1146/annurev.ne.03.030180.001201. No abstract available.
• Rolland M, Carcenac C, Overton PG, Savasta M, Coizet V. Enhanced visual responses in the superior colliculus and subthalamic nucleus in an animal model of Parkinson's disease. Neuroscience. 2013 Nov 12;252:277-88. doi: 10.1016/j.neuroscience.2013.07.047. Epub 2013 Jul 31.

Recruitment Information

• Recruitment Status: Completed
• Actual Enrollment (submitted: August 25, 2021): 23
• Original Estimated Enrollment (submitted: June 30, 2015): 40
• Actual Study Completion Date: January 19, 2018
• Actual Primary Completion Date: January 2018 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

• De novo parkinson's patients being just diagnosed (stage 1 according to the Hoehn and Yahr scale: first unilateral signs with no discomfort in everyday life) without a current dopaminergic treatment and who have not started their anti-parkinsonian treatment.
• Both Parkinson's patients and their age matching control must not present a major visual pathology (mainly in the retina) which may interfere with the visual task.
• Signed informed and free consent.
• Matching controls must not present a neurological or psychiatric troubles.
• For the matching controls: There are no contraindication on current treatments apart from those to treat other neurological disease than Parkinson's disease or psychiatric troubles.
• For Parkinson's patients: There are no contraindication on current treatments apart from those to treat neurological troubles including anti-parkinsonian treatment, or psychiatric troubles.
• As a precaution, the investigators will check that no MRI exam has been performed during the week preceding our fMRI.

Exclusion Criteria:

• Parkinson's patients with important tremor limiting the validity of the fMRI acquisition.
• Adult under supervision
• Incapacity to understand the consent explanations.
• Impossibility to participate to the whole experimental protocol.
• No affiliation to a health insurance.
• Consent not signed by a participant or refusal by the participant to participate to the experiment.
• Pregnancy or breast feeding woman.
• Administrative or justice freedom restricted participant.

Exclusion Criteria specific for MRI:

• Pacemaker, neurosensorial stimulator or implanted defibrillator.
• Presence of ocular or cerebral ferromagnetic material.
• Respiratory disease (i.e. asthma), cardio-vascular deficits, claustrophobia

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 35 Years to 75 Years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: France

Administrative Information

• NCT Number: NCT02488395
• Other Study ID Numbers: C14-58; IDRCB ( Registry Identifier: 2014-A01835-42 )
• Has Data Monitoring Committee: No
• U.S. FDA-regulated Product: Not Provided
• IPD Sharing Statement: Not Provided
• Current Responsible Party: Institut National de la Santé Et de la Recherche Médicale, France
• Original Responsible Party: Same as current
• Current Study Sponsor: Institut National de la Santé Et de la Recherche Médicale, France
• Original Study Sponsor: Same as current
• Collaborators: Not Provided

Investigators

• Principal Investigator: Elena Moro, MD/PhD; Institut National de la Santé Et de la Recherche Médicale, France
• Study Chair: Michel Dojat, PhD; Institut National de la Santé Et de la Recherche Médicale, France

• PRS Account: Institut National de la Santé Et de la Recherche Médicale, France
• Verification Date: August 2021