Parkinson Disease
Conditions
Keywords
Parkinson's disease, motor symptoms, taVNS, neural mechanism
Brief summary
This study is a double blind comparative study exploring the neural underpinnings of taVNS modulating PD motor deficits. We hypothesize that taVNS might improve PD motor deficits by regulating the balance between excitation and inhibition in the primary motor cortex.
Detailed description
Patients in the Experimental group underwent fourteen consecutive daily sessions of transcutaneous auricular vagus nerve stimulation (taVNS, twice daily, 30 minutes each time) , whereas patients in the sham stimulation group underwent fourteen consecutive daily sessions of sham taVNS with the electrodes were fixed at the left earlobe . Assessments of motor symptoms and cortical activity (using Functional near-infrared spectroscopy and Transcranial magnetic stimulation) were performed two times: at baseline, one day post intervention.
Interventions
DEVICETranscutaneous auricular vagus nerve stimulation (active）
Transcutaneous auricular vagus nerve stimulation was conducted by transcutaneous electrical stimulation therapy instrument to the cymba conchae of left ear in the vicinity of the auricular branch vagus nerve. Stimulation parameters: frequency = 20 Hz; pulse width = 500 μs, twice a day, 30 minutes each time.
DEVICETranscutaneous auricular vagus nerve stimulation (sham）
In the sham stimulation group, the electrodes were fixed at the left earlobe with the same stimulus parameters. Stimulation parameters: frequency = 20 Hz; pulse width = 500 μs, twice a day, 30 minutes each time.
Sponsors
The First Affiliated Hospital with Nanjing Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
* (1) had a diagnosis of idiopathic PD according to the Movement Disorder Society Clinical Diagnostic Criteria for PD and ON-medication Hoehn and Yahr (H&Y) stage ≤2, * (2) had stable pharmacotherapy for PD at least one month prior to the study, * (3) were aged between 40 and 80, * (4) signed written informed consent, * (5) can cooperate with the testing and taVNS treatment.
Exclusion criteria
* (1) with cognitive impairment, according to Montreal Cognitive Assessment (MOCA) \< 24; * (2) with severe tremor or levodopa-induced dyskinesia; * (3) with current intake of anticholinergics or any drugs that could induce cerebral functional change; * (4) with taVNS contraindications; * (5) received VNS treatment during the past six month; * (6) with concomitant severe neurologic, renal, cardiovascular, or hepatic disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| changes in ICF values | Assessed at baseline, one day post intervention | Test stimulus intensity was set according to an unconditioned MEP with an amplitude of \ 1 mV. For the conditioning stimulus of SICI and ICF, 80% of RMT was used. We tested interstimulus intervals (ISIs) of 10 and 15 ms for ICF. Each ISI was repeated 10 times to calculate the average value. |
| alterations in functional topological properties within the cortex of bilateral cerebral hemispheres-Sigma | Assessed at baseline, one day post intervention | Resting state fNIRS data was preprocessed to obtain the cortical oxyhemoglobin values which indicate the cortical excitability. Based on the established cortical functional network, we calculate three typical global parameters named small-worldness (Sigma) which can valuatable cortical network small world attributes. |
| alterations in functional topological properties within the cortex of bilateral cerebral hemispheres-global efficiency (Eg) | Assessed at baseline, one day post intervention | Resting state fNIRS data was preprocessed to obtain the cortical oxyhemoglobin values which indicate the cortical excitability. Based on the established cortical functional network, we calculate three typical global parameters named global efficiency (Eg) which can To evaluate the global efficiency of parallel information transmission in cortical networks. |
| alterations in functional topological properties within the cortex of bilateral cerebral hemispheres-local efficiency (Eloc) | Assessed at baseline, one day post intervention | Resting state fNIRS data was preprocessed to obtain the cortical oxyhemoglobin values which indicate the cortical excitability. Based on the established cortical functional network, we calculate typical global parameter named local efficiency (Eloc) which can evaluate functional separation in cortical networks. |
| alterations in functional topological properties within the cortex of bilateral cerebral hemispheres-nodal efficiency (Ne) | Assessed at baseline, one day post intervention | Resting state fNIRS data was preprocessed to obtain the cortical oxyhemoglobin values which indicate the cortical excitability. Based on the established cortical functional network, we calculate one nodal parameter named nodal efficiency (Ne) which can evaluate the nodal efficiency of information transmission in cortical networks. |
| changes in MEPs values | Assessed at baseline, one day post intervention | Surface electromyography (sEMG) recordings from the abductor pollicis brevis (APB) muscle were obtained to record motor evoked potentials (MEPs), which underwent amplification and filtering (bandwidth 20 Hz to 2000 Hz). |
| changes in RMT values | Assessed at baseline, one day post intervention | The individual resting motor threshold (RMT) was established as the minimum stimulus intensity required to evoke a MEP peak-to-peak amplitude of at least 0.05 mV in five of ten consecutive trials in a resting muscle. |
| changes in CSP values | Assessed at baseline, one day post intervention | The cortical silent period (CSP) was measured by sEMG of the APB following a single TMS pulse at 130% of the RMT to the opposite PMC-UL, while participants were requested to maintain active contraction of the APB at 20% of the maximum force. |
| changes in SICI values | Assessed at baseline, one day post intervention | Test stimulus intensity was set according to an unconditioned MEP with an amplitude of \ 1 mV. For the conditioning stimulus of SICI and ICF, 80% of RMT was used. We tested interstimulus intervals (ISIs) of 2 and 4 ms for SICI. Each ISI was repeated 10 times to calculate the average value. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline Unified Parkinson's Disease Rating Scale-III at one day post intervention | Assessed at baseline, one day post intervention | The measure mainly reflects the overall severity of Parkinson's disease motor symptoms. UPDRS III is a motor examination score that includes 14 items such as facial expression, tremor, rigidity, motor delay, posture disorders, and gait examination, with a total score of 0-56 points. The higher the score, the more severe the physical movement symptoms are. |
Countries
China
Contacts
Primary ContactZhang Kezhong
Outcome results
None listed