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Assessment of the Efficacy and Safety of EESS in Patients With Incomplete Spinal Cord Injuries (Parastim)

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ClinicalTrials.gov Identifier: NCT04496609
Recruitment Status : Recruiting
First Posted : August 3, 2020
Last Update Posted : August 3, 2022
Sponsor:
Information provided by (Responsible Party):
Hopital Foch

Study Description
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Brief Summary:

Neurological disability caused by traumatic lesions of the spinal cord is a significant challenge for medicine and society. These lesions, leading to sublesional central nervous system dysfunction, include sensorimotor, vesico-sphincter and genito-sexual disorders. To date, there is no treatment that enables spinal cord function to be restored.

Preclinical studies have been able to demonstrate the recovery of locomotor activity with a combination of locomotor training, pharmacological intervention and epidural electrical stimulation of the lumbosacral spinal cord (EESS) in adult rats with spinal cord transection. An American team have recently been able to show that EESS, combined with locomotor training, caused neurological improvement in four paraplegic patients, with electromyographic muscular activation patterns similar to those observed during walking. In fact, these authors also showed an improvement, under stimulation, of the VS and GS functions, but with no detailed documentation.

Starting with a conceptual and preclinical rationale, and with proof of clinical concept demonstrated in several reported cases, we propose a clinical trial with an original cross-over design to validate the hypothesis that EESS combined with training in patients with incomplete spinal cord injuries would, with a good tolerance profile, allow motor, vesico-sphincter (VS) and genito-sexual (GS) disorders to be restored in patients with incomplete spinal cord injuries.


Condition or disease Intervention/treatment Phase
Spinal Cord Injuries Device: Stimulation and automated rehabilitation / automated rehabilitation Device: Automated rehabilitation / Stimulation and automated rehabilitation Not Applicable

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 14 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Assessment of the Efficacy and Safety of Epidural Electrical Stimulation of the Lumbosacral Spinal Cord in the Symptomatic Treatment of Motor, Vesico-sphincter and Genito-sexual Disorders in Patients With Incomplete Spinal Cord Injuries
Actual Study Start Date : July 12, 2021
Estimated Primary Completion Date : July 15, 2023
Estimated Study Completion Date : July 15, 2023

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Stimulation-automated rehabilitation/automated rehabilitation
  • Stimulation and automated rehabilitation (2 sessions of 45 minutes per day) for 40 working days
  • Washout 30 days
  • Automated rehabilitation (2 sessions of 45 minutes per day) for 40 working days
 Device: Stimulation and automated rehabilitation / automated rehabilitation
Stimulation and automated rehabilitation for 40 working days, then washout during 30 days, then automated rehabilitation for 40 working days
Experimental: Automated rehabilitation/Stimulation-automated rehabilitation
  • Automated rehabilitation (2 sessions of 45 minutes per day) for 40 working days
  • Washout 30 days
  • Stimulation and automated rehabilitation (2 sessions of 45 minutes per day) for 40 working days
 Device: Automated rehabilitation / Stimulation and automated rehabilitation
Automated rehabilitation for 40 working days, then washout during 30 days, then automated rehabilitation for 40 working days


Outcome Measures
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Primary Outcome Measures :
  1. Assessment of number of patients able to move over a distance of 5 metres [ Time Frame: through study completion ]
    Determined by a capability to move over a distance of 5 metres with or without technical aid, with the option of stopping on the way


Secondary Outcome Measures :
  1. Percentage of patients capable of moving at the end of treatment [ Time Frame: 1 hour ]
    Based on the rehabilitation programme over a distance of 5 metres with or without technical aid, with the option of stopping on the way, Surface EMG, Bipodal balance measurement

  2. Assessment of vesico-sphincter function [ Time Frame: 1 hour ]
    Measurement using cystomanometry, flow measurement and assessment of post-micturition residue by means of a bladder scan

  3. Assessment of the genito-sexual function [ Time Frame: 30 minutes ]
    Measurement with MSHQ (Male Sexual Health Questionnaire) scale in men and FSFI (Female Sexual Function Index) in women MSHQ scale: minimum value (worse outcome): 7 - maximum value (better outcome): 80 FSFI scale: minimum value:2 (worse outcome) - maximum value: 36 (better outcome)

  4. Assessment of the excitability of the spinal neuronal circuits [ Time Frame: 1 hour ]
    Measurement of the reciprocal inhibition directed from the tibialis anterior to the soleus and the presynaptic inhibition applied to the fibres of the soleus by modifying the range of the soleus H-reflex obtained by percutaneous peripheral nerve electrical stimulation

  5. Assessment of the kinetics of action of the induced effects [ Time Frame: 1 hour ]
    Assessment according to the epidural electrical stimulation paradigms

  6. Assessment of capability to move over a distance of 5 metres at the end of washout period for treatment combining EESS and rehabilitation program [ Time Frame: throughout the study ]
    Measurement of covered distance at the end of washout period for treatment combining EESS and rehabilitation program

  7. Assessment of capability to move over a distance of 5 metres at the end of washout period for rehabilitation program [ Time Frame: 30 minutes ]
    Measurement of covered distance at the end of washout period for rehabilitation program

  8. Assessment of capability to move over a distance of 5 metres after 6 months of treatment [ Time Frame: Month 6 ]
    Measurement of covered distance after 6 months of treatment

  9. Assessment of vesico-sphincter function at the end of washout period for treatment combining EESS and rehabilitation program [ Time Frame: 1 hour ]
    Measurement using cystomanometry, flow measurement and assessment of post-micturition residue by means of a bladder scan

  10. Assessment of vesico-sphincter function at the end of washout period for rehabilitation program [ Time Frame: 1 hour ]
    Measurement using cystomanometry, flow measurement and assessment of post-micturition residue by means of a bladder scan

  11. Assessment of vesico-sphincter function after 6 months of treatment [ Time Frame: Month 6 ]
    Measurement using cystomanometry, flow measurement and assessment of post-micturition residue by means of a bladder scan

  12. Assessment of the genito-sexual function at the end of washout period for treatment combining EESS and rehabilitation program [ Time Frame: 30 minutes ]
    Measurement with MSHQ (Male Sexual Health Questionnaire) scale in men and FSFI (Female Sexual Function Index) in women MSHQ scale: minimum value (worse outcome): 7 - maximum value (better outcome): 80 FSFI scale: minimum value:2 (worse outcome) - maximum value: 36 (better outcome)

  13. Assessment of the genito-sexual function at the end of washout period for rehabilitation program [ Time Frame: 30 minutes ]
    Measurement with MSHQ (Male Sexual Health Questionnaire) scale in men and FSFI (Female Sexual Function Index) in women MSHQ scale: minimum value (worse outcome): 7 - maximum value (better outcome): 80 FSFI scale: minimum value:2 (worse outcome) - maximum value: 36 (better outcome)

  14. Assessment of the genito-sexual function after 6 months of treatment [ Time Frame: Month 6 ]
    Measurement with MSHQ (Male Sexual Health Questionnaire) scale in men and FSFI (Female Sexual Function Index) in women MSHQ scale: minimum value (worse outcome): 7 - maximum value (better outcome): 80 FSFI scale: minimum value:2 (worse outcome) - maximum value: 36 (better outcome)

  15. Assessment of the excitability of the spinal neuronal circuits at the end of washout period for treatment combining EESS and rehabilitation program [ Time Frame: 1 hour ]
    Measurement of the reciprocal inhibition directed from the tibialis anterior to the soleus and the presynaptic inhibition applied to the fibres of the soleus by modifying the range of the soleus H-reflex obtained by percutaneous peripheral nerve electrical stimulation

  16. Assessment of the excitability of the spinal neuronal circuits at the end of washout period for rehabilitation program [ Time Frame: 1 hour ]
    Measurement of the reciprocal inhibition directed from the tibialis anterior to the soleus and the presynaptic inhibition applied to the fibres of the soleus by modifying the range of the soleus H-reflex obtained by percutaneous peripheral nerve electrical stimulation

  17. Assessment of the excitability of the spinal neuronal circuits after 6 months of treatment [ Time Frame: 1 hour ]
    Measurement of the reciprocal inhibition directed from the tibialis anterior to the soleus and the presynaptic inhibition applied to the fibres of the soleus by modifying the range of the soleus H-reflex obtained by percutaneous peripheral nerve electrical stimulation

  18. Assessment of quality of life [ Time Frame: 30 minutes ]
    Measurement with EQ5D-3L (EuroQol 5 Dimensions - 3 Levels) scale

  19. Number of patient with AE/SAE related to tolerance [ Time Frame: through study completion ]
    Reporting of AE and SAE

  20. Number of patient with AE/SAE related to safety [ Time Frame: through study completion ]
    Reporting of AE and SAE


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Aged between 18 and 65 years inclusive
  • Male or female
  • Incomplete ASIA B or C spinal cord lesion with level of lesion located above T10 (sensation preserved below level of lesion)
  • Absence of significant motor deficit of the upper limbs or recovered motor deficit (muscular score ≥ 4/5)
  • Patient with spinal cord injury at least 2 years old and considered stable not walking
  • Spinal cord lesion determined by spinal cord MRI (intramedullary hypersignal)
  • Patient who can benefit from an iterative rehabilitation programme
  • Patient with stable health condition with no cardiopulmonary disease
  • Patient with orthopaedic condition compatible with verticality and walking
  • Persistence of adductor reflexes up to L2
  • Patient with no current neuromodulation implant: spinal cord neurostimulator, brain, peripheral nerve or intrathecal treatment
  • Patient with no coagulopathy, cardiac risk factors or other medical risk factors significant for surgery
  • Local anatomical conditions compatible with implantation of the epidural electrode (determined by MRI of the spinal cord)
  • Person who benefits from or is entitled to a social security scheme
  • Having provided signed informed consent

Exclusion Criteria:

  • Significant cerebral lesion on a previous cerebral MRI
  • Psychiatric or cognitive disorder history (known or detected during the consultation with the psychologist)
  • Protected adult patients
  • Pregnant (determined by a negative pregnancy test) or breastfeeding women
  • Respiratory failure (vital capacity < 50%) (surgery in prone position)
  • Repeated urinary infections (≥3 per year)
  • Planned absence that may hinder participation in the study (travelling abroad, relocation, imminent moving)
  • Patients with spasms (PENN scale > 2)
  • Cauda equina syndrome
  • Patients presenting with a contraindication to an MRI being carried out: i) pacemaker, ii) non-MRI-compatible heart valve, iii) clips, stents, coils, etc. that are not MRI-compatible, iv) cochlear implant, v) metal foreign body, etc.)
  • Patients presenting with a contraindication to MEPs being carried out (notably wearing of ferromagnetic material, heart stimulator)
  • Patients on oral anticoagulants
  • Patients with botulinic toxin injection
  • Patients with bedsore
  • Undernourished patients (BMI < 19)
Contacts and Locations
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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 ClinicalTrials.gov identifier (NCT number): NCT04496609


Contacts
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Contact: Elisabeth Hulier-Ammar +33 1 46 25 11 75 drci-promotion@hopital-foch.com

Locations
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France
Hôpital Raymond Poincaré Recruiting
Garches, France, 92380
Contact: Nicolas Roche, MD    +33 1 47 10 79 00    nicolas.roche@aphp.fr   
Principal Investigator: Nicolas Roche, MD         
Hôpital Foch Recruiting
Suresnes, France, 92150
Contact: Béchir Jarraya, MD    +33 1 46 25 29 66    b.jarraya@hopital-foch.com   
Principal Investigator: Béchir Jarraya, MD         
Sponsors and Collaborators
Hopital Foch
Investigators
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Principal Investigator: Béchir Jarraya, MD Hôpital Foch
More Information
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Responsible Party: Hopital Foch
ClinicalTrials.gov Identifier: NCT04496609    
Other Study ID Numbers: 2016/50
First Posted: August 3, 2020    Key Record Dates
Last Update Posted: August 3, 2022
Last Verified: August 2022

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Spinal Cord Injuries
Wounds and Injuries
Spinal Cord Diseases
 Central Nervous System Diseases
Nervous System Diseases
Trauma, Nervous System