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ExAblate Pallidotomy for Medically-Refractory Dyskinesia Symptoms or Motor Fluctuations of Advanced Parkinson's Disease

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT03319485
Recruitment Status : Recruiting
First Posted : October 24, 2017
Last Update Posted : June 18, 2019
Information provided by (Responsible Party):

Brief Summary:
Evaluate the safety and efficacy of unilateral focused ultrasound pallidotomy using the ExAblate 4000 System in the management of dyskinesia symptoms or motor fluctuations for medication refractory, advanced idiopathic Parkinson's disease.

Condition or disease Intervention/treatment Phase
Parkinson Disease Device: ExAblate Pallidotomy Device: Sham ExAblate Pallidotomy Not Applicable

Detailed Description:
The goal of this prospective, two-arm, sham-controlled, randomized, multi-center pivotal study is to evaluate the safety and efficacy of unilateral focused ultrasound pallidotomy using the ExAblate 4000 System in the management of dyskinesia symptoms or motor fluctuations for medication refractory, advanced idiopathic Parkinson's disease.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 92 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Pivotal Clinical Trial of the Management of the Medically-Refractory Dyskinesia Symptoms or Motor Fluctuations of Advanced Idiopathic Parkinson's Disease With Unilateral Lesioning of the Globus Pallidum Using the ExAblate Neuro System
Actual Study Start Date : February 9, 2018
Estimated Primary Completion Date : December 31, 2019
Estimated Study Completion Date : December 31, 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: ExAblate Pallidotomy
ExAblate treatment for Advanced Idiopathic Parkinson's Disease
Device: ExAblate Pallidotomy
ExAblate Pallidotomy for Parkinson's Disease
Other Names:
  • MRgFUS
  • Pallidotomy

Sham Comparator: Sham ExAblate Pallidotomy
Sham (fake) treatment
Device: Sham ExAblate Pallidotomy
ExAblate MRgFUS Sham Procedure

Primary Outcome Measures :
  1. Responder Analysis [ Time Frame: Change in UDysRS and MDS-UPDRS Part III Motor Exam score from before treatment to 3 months following treatment ]
    Responder is defined as the patient reaching a minimally clinically significant difference on: 1. UDysRS (this measures dyskinesia and their impact) OR 2. MDS-UPDRS Part III Motor Exam -Total score (this measures overall motor fluctuations).

Secondary Outcome Measures :
  1. Severity of Device and Procedure related complications [ Time Frame: At the time of ExAblate Pallidotomy procedure ]
    To evaluate of the incidence and severity of device- and procedure-related

Information from the National Library of Medicine

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Ages Eligible for Study:   30 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Men and women, age 30 years and older.
  2. Subjects who are able and willing to give informed consent and able to attend all study visits through 12 Months.
  3. Subjects with a diagnosis of idiopathic PD by UK Brain Bank Criteria as confirmed by a movement disorder neurologist at the site.
  4. Levodopa responsive as defined by at least a 30% reduction in MDS-UPDRS motor subscale in the ON vs OFF medication state.
  5. MDS-UPDRS score of ≥ 20 in the meds OFF condition OR Motor complications of PD on optimum medical treatment .
  6. Subjects should be on a stable dose of all PD medications for 30 days prior to study entry as determined by medical records.
  7. Subject is able to communicate sensations during the ExAblate procedure.
  8. Subjects on stable antidepressant medications for at least 3 months

Exclusion Criteria:

  1. Hoehn and Yahr stage in the ON medication state of 3 or greater.
  2. Presence of other central neurodegenerative disease suspected on neurological examination. These include: multisystem atrophy, progressive supranuclear palsy, corticobasal syndrome, dementia with Lewy bodies, and Alzheimer's disease.
  3. Any suspicion that Parkinsonian symptoms are a side effect from neuroleptic medications.
  4. Subjects who have had deep brain stimulation or a prior stereotactic ablation of the basal ganglia.
  5. Presence of significant cognitive impairment using MMSE ≤ 24.
  6. Unstable psychiatric disease, defined as active uncontrolled depressive symptoms, psychosis, delusions, hallucinations, or suicidal ideation.
  7. Subjects with an active alcohol or drug dependency or history of drug/alcohol abuse within the past year
  8. Subjects with unstable cardiac status
  9. Severe hypertension (diastolic BP > 100 on medication).
  10. Current medical condition resulting in abnormal bleeding and/or coagulopathy.
  11. Receiving anticoagulant (e.g., warfarin) or antiplatelet (e.g., aspirin) therapy within one week of focused ultrasound procedure or drugs known to increase risk or hemorrhage (e.g., Avastin) within one month of focused ultrasound procedure.
  12. Subjects with risk factors for intraoperative or postoperative bleeding as indicated by: platelet count less than 100,000 per cubic millimeter; a documented clinical coagulopathy; or INR coagulation studies exceeding the institution's laboratory standard
  13. Patient with kidney disease or on dialysis.
  14. Subjects with standard contraindications for MR imaging
  15. Significant claustrophobia that cannot be managed with mild medication.
  16. Subjects who weigh more than the upper weight limit of the MR scanner table and who cannot fit into the MR scanner.
  17. Subjects who are not able or willing to tolerate the required prolonged stationary supine position during treatment.
  18. History of intracranial hemorrhage, multiple strokes, or a stroke within past 6 months.
  19. Subjects with a history of seizures within the past year.
  20. Subjects with brain tumors.
  21. Subjects with intracranial aneurysms requiring treatment or arterial venous malformations (AVMs) requiring treatment.
  22. Are participating or have participated in another clinical trial in the last 30 days.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03319485

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United States, California
Stanford University Medical Center Recruiting
Stanford, California, United States, 94305
Contact: Vyvian Ngo, MPH    650-498-0817   
Principal Investigator: Casey H Halpern, MD         
United States, Florida
Palm Beach Neuroscience Institute/Sperling Medical Group Recruiting
Boynton Beach, Florida, United States, 33472
Contact: Arif Dalvi, MD    561-882-6214      
Principal Investigator: Arif Dalvi, MD         
United States, Maryland
University of Maryland Medical System Recruiting
Baltimore, Maryland, United States, 21201
Contact: Charlene Aldrich    410-328-5332   
Principal Investigator: Howard Eisenberg, MD         
Sub-Investigator: Paul Fishman, MD         
United States, Massachusetts
Brigham and Women's Hospital Recruiting
Boston, Massachusetts, United States, 02115
Contact: Taylor Krozy    617-732-8527   
Principal Investigator: Rees Cosgrove, MD         
United States, Minnesota
Mayo Clinic Recruiting
Rochester, Minnesota, United States, 55905
Contact: Sandy Looney    507-538-4107   
Principal Investigator: Bryan Klassen, MD         
United States, New York
Weill Cornell Medicine Recruiting
New York, New York, United States, 10065
Contact: Marissa Michael    212-746-7373   
Principal Investigator: Michael G. Kaplitt, MD, PhD         
United States, Ohio
The Ohio State Wexner Medical Center Recruiting
Columbus, Ohio, United States, 43210
Contact: Erin Woodburn    614-366-7822   
Principal Investigator: Vibhor Krishna, MD         
United States, Pennsylvania
Pennsylvania Hospital Department of Neurosurgery Recruiting
Philadelphia, Pennsylvania, United States, 19106
Contact: Marie Kerr    215-829-6720   
Principal Investigator: Gordon H Baltuch, MD         
United States, Virginia
University of Virginia Health System Recruiting
Charlottesville, Virginia, United States, 22908
Contact: Matthew Patterson, MS    434-243-7336   
Principal Investigator: W Jeff Elias, MD         
United States, Washington
Swedish Medical Center Recruiting
Seattle, Washington, United States, 98122
Contact: Laura Johnson    206-320-7115 ext x27115   
Principal Investigator: Ryder P. Gwinn, MD         
Principal Investigator: Pravin Khemani, MD         
Canada, Ontario
Toronto Western Hospital Recruiting
Toronto, Ontario, Canada, M5T 2S8
Contact: Martha Lenis    416-603-5800 ext 2797   
Principal Investigator: Andres Lozano, MD         
Rambam Health Care Recruiting
Haifa, Israel, 3109601
Contact: Marius Constantinescu, MD    972-4-7772640   
Contact: Alon Sinai, MD    972-4- 7772432   
Fondazione IRCCS Neurological Institute Carlo Besta Recruiting
Milan, Italy, 20133
Contact: Roberto Eleopra    00390223942954   
Principal Investigator: Roberto Eleopra, MD         
Korea, Republic of
Severance Hospital, Yonsei University Health System Recruiting
Seoul, Korea, Republic of
Contact: Seohee Park    010-3779-7898   
Contact: Huh Nayoung    02-2228-0481   
Principal Investigator: Jin Woo Chang, Prof.         
United Kingdom
St. Mary's Hospital Recruiting
London, United Kingdom
Contact: Lesley Honeyfield    +44 (0) 20 331 10327   
Sub-Investigator: Wladyslaw M W Gedroyc, Prof.         
Sub-Investigator: Peter Bain, Dr.         
Sub-Investigator: Dipankar Nandi, Mr.         
Sponsors and Collaborators

Additional Information:
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Responsible Party: InSightec Identifier: NCT03319485     History of Changes
Other Study ID Numbers: PD006
First Posted: October 24, 2017    Key Record Dates
Last Update Posted: June 18, 2019
Last Verified: June 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: No

Keywords provided by InSightec:

Additional relevant MeSH terms:
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Parkinson Disease
Parkinsonian Disorders
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Movement Disorders
Neurodegenerative Diseases
Neurologic Manifestations
Signs and Symptoms