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Use of Interventional MRI for Implantation of Deep Brain Stimulator Electrodes (iMRI)
This study is currently recruiting participants.
Verified by University of California, San Francisco, November 2008
Sponsors and Collaborators: University of California, San Francisco
Surgi-Vision Inc
Information provided by: University of California, San Francisco
ClinicalTrials.gov Identifier: NCT00792532
  Purpose

The purpose of this study is to determine the safety and effectiveness of a new procedure for placing DBS electrodes, in which the entire surgery is performed within an MRI scanner ("interventional MRI"), with the patient fully asleep (under general anesthesia). The standard method for the placement of deep brain stimulators does not use MRI during the actual DBS placement. The standard method involves placement of a rigid frame on the patient's head, performance of a short MRI scan, transport to the operating room, placement of the DBS electrodes in the operating room, and return to the MRI suite for another MR to confirm correct electrode placement. In the standard method, the patient must be awake for 2-4 hours in the operating room to have "brain mapping" performed, where the brain target is confirmed by passing "microelectrodes" (thin wires) into the brain to record its electrical activity. In the standard method, general anesthesia is not required. In this study, the surgery is guided entirely by MRI images performed multiple times as the DBS electrode is advanced. This eliminates the need for the patient to be awake, and eliminates the need for passing microelectrodes into the brain before placing the permanent DBS electrode.


Condition Intervention Phase
Parkinson's Disease
Dystonia
Procedure: interventional MRI for implantation of DBS electrodes
Device: DBS electrodes
Phase I

Genetics Home Reference related topics: early-onset primary dystonia familial paroxysmal nonkinesigenic dyskinesia Parkinson disease
MedlinePlus related topics: Dystonia Parkinson's Disease
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study
Official Title: Use of Interventional MRI for Implantation of Deep Brain Stimulator Electrodes

Further study details as provided by University of California, San Francisco:

Primary Outcome Measures:
  • Parkinson's disease: The degree of benefit from baseline off medication UPDRS(part III) motor score to postoperative off medication scores at 12 months with stimulation on. [ Time Frame: 12 months post-surgery ] [ Designated as safety issue: No ]
  • Dystonia: The percent change from baseline in the Burk-Fahn-Marsden Dystonia rating scale movement subscore to the 12 month postoperative subscore [ Time Frame: 12 months post-surgery ] [ Designated as safety issue: No ]

Estimated Enrollment: 100
Study Start Date: July 2003
Estimated Study Completion Date: July 2013
Estimated Primary Completion Date: July 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
iMRI: Experimental Procedure: interventional MRI for implantation of DBS electrodes
DBS implantation will be performed entirely within a Phillips 1.5T MRI scanner at UCSF and the Siemens Avanto 1.5T MRI scanner at the SFVAMC.
Device: DBS electrodes
Deep brain stimulation (DBS) electrodes

Detailed Description:

Deep brain stimulation (DBS) is a new but increasingly common surgical technique for the treatment of Parkinson's disease. The current technical approach to DBS implantation involves frame-based stereotaxy. In this method, a stereotactic frame is rigidly fixed to the patient's skull, an MRI is obtained, an anatomic target is identified, and the coordinates of the target in stereotactic space are calculated. Instruments are mounted on the stereotactic frame that point to the calculated coordinate. However, due to the inherent inaccuracies in standard frame-based stereotaxy, a complex 6-hour procedure then ensues to "map" the brain target with microelectrodes, place the lead, and return to the MR unit to confirm proper placement.

The goal of this project is to test the feasibility of performing DBS implantation entirely within the Phillips 1.5T open magnet MRI machine. Prior to study initiation, instrumentation and MR protocols were tested using a phantom head. In the proposed project, subthalamic nucleus or gGlobus pPallidus DBS implantations will be performed bilaterally in patients with Parkinson's disease or dystonia. Patients will be under general anesthesia. Targeting and lead verification are performed with imaging alone, without physiologic mapping. Data is to be gathered on the following: Operative time, degree of benefit with bilateral implantation (changes in standard rating scales of motor disability), DBS voltage requirements, complications), and electrode location by MR. These measures will be compared with our historical controls, previously entered into our research database, in which electrodes were placed by the standard methods. We expect that the use of near real time MR will improve the speed and accuracy of DBS implantation, and eliminate the need for invasive physiological monitoring.

  Eligibility

Ages Eligible for Study:   7 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Parkinson's Disease

Inclusion Criteria:

  1. Diagnosis of bilateral, idiopathic PD with clinically significant motor fluctuations despite maximized antiparkinsonian therapy. This will be based on medical history, neurologic examination (the presence of at least 2 of the following: resting tremor, rigidity, or bradykinesia), and response to antiparkinsonian therapy.
  2. At least 5 years' duration, relative to the date of surgery, since diagnosis of PD.
  3. Age >21 inclusive, on date of surgery.
  4. The subject is ambulatory in their best on time (not wheelchair bound).
  5. The subject is medically able to undergo the surgery as determined by clinical and laboratory evaluations and any other evaluations that are part of the standard practice at the institution in which the subject is to undergo surgery (e.g., subjects will have normal coagulation tests and normal platelet levels).
  6. The subject is expected to be able to comply with and understand the required visit schedule and all required tests and procedures.
  7. Signed IRB-approved informed consent is obtained before any study-specific procedure, including assessments required during the eligibility evaluation period.

Exclusion Criteria:

  1. In the judgment of the investigator, a history of any clinically significant medical, psychiatric, or laboratory abnormality for which participation in the study would pose a safety risk to the subject.
  2. History of treatment of PD by any procedure involving intracranial surgery or implantation of a device.
  3. MRI of the brain within 12 months before the surgery which demonstrates an intracranial abnormality that would contraindicate surgery (e.g. stroke, tumor, vascular abnormality affecting the DBS target area).
  4. Any disorder that precludes a surgical procedure (e.g., signs of sepsis or inadequately treated infection) or alters wound healing.
  5. Receipt of antiplatelet agents for at least 10 days prior surgery.
  6. A score of less than or equal to 24 on the Folstein Mini-Mental examination performed during the eligibility evaluation period.
  7. History of significant psychiatric illness, epilepsy, or Alzheimer's disease.
  8. Active drug or alcohol abuse.
  9. Pregnancy or lack of effective contraception in women of childbearing potential defined as one year post-menopausal or surgically sterile.
  10. Treatment with nonantiparkinsonian agents (e.g., atypical neuroleptics) that may affect symptoms of PD within 60 days before entering the study.
  11. Any medical disability (e.g., severe degenerative arthritis, compromised nutritional state, severe peripheral neuropathy) that would interfere with the assessment of safety and efficacy in this trial.
  12. Inability to follow-up with post-operative study visits

Dystonia Inclusion Criteria

  1. Idiopathic or secondary dystonia diagnosed by a movement disorders neurologist
  2. Significant functional impairment despite optimal medical management, including failed botulinum toxin therapy if appropriate
  3. Age >7 years inclusive, on date of surgery.
  4. The subject is medically able to undergo the surgery as determined by clinical and laboratory evaluations and any other evaluations that are part of the standard practice at the institution in which the subject is to undergo surgery (e.g., subjects will have normal coagulation tests and normal platelet levels).
  5. The subject is able to comply with and understand the required visit schedule and all required tests and procedures.
  6. Signed IRB-approved informed consent is obtained before any study-specific procedure, including assessments required during the eligibility evaluation period.

Exclusion Criteria

  1. Patients considered at high risk for elective neurosurgery because of co-morbid conditions
  2. Pregnancy
  3. Inability to follow-up with post-operative study visits
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00792532

Locations
United States, California
University of California, San Francisco Recruiting
San Francisco, California, United States, 94143
Contact: Jamie Grace, B.S.     415-353-8328     jamie.grace@ucsf.edu    
Contact: Monica Volz, M.S.N.     415-502-3576     monica.volz@ucsf.edu    
San Francisco Veterans Administration Medical Center Recruiting
San Francisco, California, United States, 94121
Contact: Susan Heath, M.S.N.     415-221-4810 ext 2505     Susan.Heath@va.gov    
Contact: Paul Larson, M.D.     415-221-4810 ext 4791     larsonp@neurosurg.ucsf.edu    
Sponsors and Collaborators
University of California, San Francisco
Surgi-Vision Inc
Investigators
Principal Investigator: Philip Starr, M.D. University of California, San Francisco; SFVAMC
Principal Investigator: Paul Larson, M.D. University of California, San Francisco; SFVAMC
Principal Investigator: Jill L Ostrem, MD University of California San Francisco, SFVAMC
Principal Investigator: Alastair J Martin, PhD University of California, San Francisco
  More Information

Publications of Results:
Responsible Party: University of California, San Francisco ( Philip Starr, M.D., Ph.D )
Study ID Numbers: iMRI
Study First Received: November 14, 2008
Last Updated: November 24, 2008
ClinicalTrials.gov Identifier: NCT00792532  
Health Authority: United States: Institutional Review Board

Study placed in the following topic categories:
Dystonic Disorders
Ganglion Cysts
Basal Ganglia Diseases
Dystonia
Central Nervous System Diseases
Brain Diseases
Neurodegenerative Diseases
Dyskinesias
Signs and Symptoms
Parkinson Disease
Movement Disorders
Neurologic Manifestations
Parkinsonian Disorders

Additional relevant MeSH terms:
Nervous System Diseases

ClinicalTrials.gov processed this record on January 15, 2009