Convection Enhanced Delivery of CSF in DBS for Parkinson's

Study Overview
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Brief Summary
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This study will evaluate safety foremost but also the distribution and initial effectiveness of infusion-enhanced, MRI-guided DBS for patients with medication-refractory, Parkinson's disease

Detailed Description
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This is an open-label, single-arm, pilot study investigating the safety and feasibility of infusion-enhanced, MRI-guided DBS electrode placement. The investigators intend to enroll patients with Parkinson's disease and medically-refractory motor symptoms, who are already planned for MRI-guided DBS electrodes under general anesthesia. The hypothesis of the study is that a convective micro-infusion of autologous CSF will enhance the T2-weighted MRI visualization of the targeted nucleus during image-guided DBS surgery for Parkinson's disease. The investigators will record standard clinical measures of PD at baseline and 6 months following DBS surgery. The study will recruit patients at a rate of approximately one a month and will take less than two years to complete.

Official Title
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Convection Enhanced Delivery of Autologous Cerebral Spinal Fluid Improves MRI Visualizations of Basal Ganglion Nuclei During Deep Brain Stimulation Surgery

Conditions
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Parkinson Disease

Intervention / Treatment
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* Device: Intracerebral Infusion of Autologous Cerebral Spinal Fluid


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women, age 30 years and older Subjects with advanced PD who are scheduled for MRI-guided DBS surgery under general anesthesia Subjects who are able and willing to give informed consent and able to attend clinic visits through 6 months The target nucleus, GPi or STN, is visible on MRI so that it can be targeted for the study infusion and then for MRI-guided DBS Exclusion Criteria: DBS surgery planned in the awake condition with microelectrode recordings and clinical testing Spinal pathology not amenable to lumbar puncture Subjects who have had deep brain stimulation or a prior stereotactic ablation of the basal ganglia Legal incapacity or limited legal capacity as determined by the neuropsychologist Are participating or have participated in another clinical trial in the last 30 days Any illness that in the investigator's opinion preclude participation in this study.

Ages Eligible for Study
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Minimum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intracerebral Infusion of Autologous CSF<br>All subjects will receive the intracerebral infusion of autologous cerebral spinal fluid (CSF) during their deep brain stimulation (DBS) surgery. The DBS surgery will be performed on the targeted nucleus either bilaterally or unilaterally, as previously determined by a multidisciplinary team of neurology, neurosurgery, and neuropsychology. During unilateral DBS surgery, the targeted nucleus will be infused using convection enhanced delivery (CED). The nondominant side will be infused during a bilateral DBS procedure. | Device: Intracerebral Infusion of Autologous Cerebral Spinal Fluid<br>* Unilateral infusion of 0.5 ml autologous CSF before DBS electrode insertion with MRI monitoring<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Adverse Events That Are Related to Treatment | Safety will be determined by an evaluation of the incidence and severity of infusion-related side effects and complications from the first treatment day visit through the 6-month post-treatment time point. All AEs will be reported and categorized by investigators as definitely, probably, possibly, unlikely, or unrelated to the CSF infusion, and/or Parkinson's disease progression. Safety will be assessed by incidence and severity of AEs, including changes in physical examinations and neurological examinations, and the number of discontinuations due to AEs. | 6 months postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| % Change in Un-medicated UPDRS, Motor Subsection (Part III) From Baseline to 6 Months | The efficacy endpoint will be focused on determining the degree of change in motor symptoms as measured from the in-medicated UPDRS, motor subsection (Part III). | 6 months postoperatively in comparison to baseline | 
| Vd/Vi Ratio | The ratio of the volume of distribution (Vd) immediately following the infusion (Vi) with intraoperative 1.5T MRI, T2-weighted sequences to the volume of the infusion (Vi) will be calculated. Each volume is measured in microliters (uL). The distribution of the infusion by convective properties in a deep brain human nucleus (GPi or STN) will be determined by calculating the Vd/Vi ratio. | Day of Surgery | 
| Baseline Levodopa Medication Equivalents (Milligrams) |  | Baseline | 
| Change in Quality of Life Assessment With PDQ-39 Questionnaire | The PDQ-39 questionnaire includes 39 quality of life questions rated on a scale of 0-4. 0 indicating least frequent (never) and 4 indicating most frequent (always). The mean change in the sum of the PDQ-39 questionnaire is being reported with a overall score of 0 being the best quality of life and a maximum score of 156 being the worst possible quality of life. | 6 months postoperatively in comparison to baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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DBS