Augmenting Treatment Effects of Voice Therapy in Parkinson Disease

Overview

The purpose of this study is to evaluate the impact of a non-invasive brain stimulation technique called transcranial magnetic stimulation (TMS) on voice/speech treatment in people with Parkinson's Disease (PD), through the use of speech and voice analysis, examination of voice box, and brain imaging methods.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Factorial Assignment
    • Primary Purpose: Treatment
    • Masking: Double (Participant, Care Provider)
  • Study Primary Completion Date: December 31, 2020

Detailed Description

Effective treatment of the speech disorder in IPD is as important as the optimal control of limb motor symptoms. Presently, the Lee Silverman Voice Treatment (LSVTÒ LOUD) – is a time intensive behavioral treatment for Parkinson's hypophonia. Facilitatory TMS is a safe and a complimentary stimulation technique. Brain imaging has also identified suitable target brain regions that are readily accessible to TMS. This combined treatment modality approach should be more effective and efficient the LSVT alone. The study will enroll patients with Parkinson's disease with moderate to severe hypophonia. A total of 36 patients will be recruited over 3 years and divided into 3 groups (n=12 each). The three cohorts are: 1. LSVT +sham TMS; 2. LSVT +left rTMS and 3. LSVT + right rTMS. This is a longitudinal double blind randomized controlled clinical trial. All investigators and study personnel will be blind to the study except for the PI responsible for TMS (Dr. Narayana). The entire protocol occurs over 19 weeks. During the first week, the participants will be screened, consented. During the second week, baseline behavioral and imaging data will be collected. Next, the patients will be randomized to one of the three treatment groups. Then the patients will enter a 4-week treatment phase, where they will receive TMS/sham TMS and LSVT 4 days a week for 4 weeks. During the seventh week, patients will undergo post treatment behavioral and imaging assessments. Then the patients will return in week 19 to complete the follow up behavioral measures and imaging session.

Interventions

  • Other: Transcranial Magnetic Stimulation
    • Treament adjuvant applied to accelerate vocal motor learning and overall voice improvement
  • Behavioral: Lee Silverman Voice Treatment
    • Time intensive behavioral treatment for Parkinson’s hypophonia

Arms, Groups and Cohorts

  • Sham Comparator: LSVT +sham TMS
    • Lee Silverman Voice Treatment (LSVT) and Transcranial Magnetic Stimulation (TMS)
  • Active Comparator: LSVT +left rTMS
    • Lee Silverman Voice Treatment (LSVT) and Transcranial Magnetic Stimulation (TMS) applied to left side of head
  • Active Comparator: LSVT + right rTMS
    • Lee Silverman Voice Treatment (LSVT) and Transcranial Magnetic Stimulation (TMS) applied to right side of brain

Clinical Trial Outcome Measures

Primary Measures

  • Clinical assessment:
    • Time Frame: 19 weeks
    • Voice intensity and overall voice quality
  • Patient assessment:
    • Time Frame: 19 weeks
    • 10-item Voice related Quality of Life Scale (V-RQOL)
  • Physiological assessment:
    • Time Frame: 19 weeks
    • Vocal fold function; Changes in brain activation: at the site of TMS stimulation and the speech motor network; and Functional connectivity within the speech motor network

Secondary Measures

  • Clinical assessment
    • Time Frame: 19 weeks
    • intelligibility and articulation
  • Patient self-assessment
    • Time Frame: 19 weeks
    • visual analog scaling of speech intelligibility

Participating in This Clinical Trial

Inclusion Criteria

  • Individuals with Idiopathic Parkinson's disease (IPD) between the ages of 45 and 80 years with moderate to severe hypophonia – None or mild cognitive impairment or depression – Stable medication therapy for at least 3 months. Must be "optimally medicated" at the start of the study. This means that there should be no change in mediction type or dosage in 3 months prior to enrolling in the study. The medications should not be causing significant or serious advese effects Exclusion Criteria:

  • History of drug abuse or neurological condition other than or in addition to IPD (for example stroke) – Individuals with advanced IPD (stage V) or who had LSVT within 3 years – Pregnant females – History of seizures, history of major head trauma, metal objects implanted in the head, ferrous metal filings in the eye, brain damage, inflammation of the brain, cardiac pacemaker, implanted medication pump, cardiac lines, heart disease, currently taking certain types of medication for depression or seizures (tricyclic antidepressants or neuroleptics which lower seizure threshold

Gender Eligibility: All

Minimum Age: 45 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Le Bonheur Children’s Hospital
  • Collaborator
    • Michael J. Fox Foundation for Parkinson’s Research
  • Provider of Information About this Clinical Study
    • Principal Investigator: James W. Wheless, Shalini Narayana, Ph.D. – Le Bonheur Children’s Hospital
  • Overall Official(s)
    • Shalini Narayana, PhD, Principal Investigator, LeBonheur Children’s Hospital

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