Respiratory-gated Transcutaneous Auricular Vagus Nerve Stimulation for Improving Apathy in Parkinson's Disease

Anhui Medical University60 enrolled

Overview

The goal of this clinical trial is to learn whether 100HZ respiratory-gated vagus nerve stimulation (RAVANS) can improve the non-motor symptoms in people with Parkinson's disease (PD). It will also learn the safety of 100HZ RAVANS. The main questions it aims to answer are: Can 100HZ RAVANS improve apathy in people with PD? Did the participants have any side effects or safety issues when undergoing 100HZ RAVANS? Researchers compared 100HZ RAVANS with sham stimulation (low-dose stimulation of the same site and treatment parameters) to see if 100HZ RAVANS could improve non-motor symptoms in patients with PD. Participants will: Receive 100HZ RAVANS or sham stimulation for 2 weeks. Neuropsychological assessment, imaging and biological sample collection were conducted before and after the entire cycle.

This study employs a double-blind, sham-controlled design to further validate the effects of 100Hz RAVANS on apathy . Patients were randomized into real or sham stimulation groups. Both groups will receive RAVANS once daily, with each session lasting 30 minutes, for a total duration of two weeks. The study design will include neuropsychological assessments, imaging, and biological specimen collection before and after the entire cycle.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Parkinson Disease Apathy

Interventions

Active RAVANSOTHER

Real RAVANS was performed on the cymba conchae of left ear in the vicinity of the auricular branch vagus nerve according to the Participant's respiratory rhythm. Stimulation parameters: frequency = 100 Hz; pulse width = 200 us, once a day, 30 minutes each time, one second of stimulation occurs during exhalation.

Sham RAVANSOTHER

Sham RAVANS was performed on on the cymba conchae of left ear according to the Participant's respiratory rhythm. Stimulation parameters: frequency = 100 Hz; pulse width = 200 us, once a day, 30 minutes each time, one second of stimulation occurs during exhalation and the interval between stimulus is 29 seconds.

Eligibility

Sex: ALLMin age: 40 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Meet the diagnostic criteria for idiopathic Parkinson's disease (based on the MDS Clinical Diagnostic Criteria for Parkinson's Disease (2015 version)). 2. Patients with Apathy Motivation Index (AMI) score \>1.7. 3. All PD patients must be on stable, standardized medication regimens with no adjustments to medications for at least 1 month prior to the study and throughout the study period. 4. Demonstrate good compliance and adherence, capable of completing behavioral tests and taVNS therapy. 5. Mini-Mental State Examination (MMSE) score ≥22. 6. Meet safety criteria for MRI screening. Exclusion Criteria: 1. Prior brain MRI/CT showing focal brain lesions or severe white matter disease (Fazekas grade 3 or higher). 2. Secondary parkinsonism (e.g., vascular parkinsonism, drug-induced parkinsonism). 3. History of severe traumatic brain injury, neurosurgery, or deep brain stimulation (DBS) therapy. 4. Personal history of epilepsy, unexplained loss of consciousness, or current use of anticonvulsant medications for seizure control. 5. Diagnosis of neuropsychiatric disorders other than Parkinson's disease. 6. Current use of non-steroidal anti-inflammatory drugs (NSAIDs) or Non-benzodiazepine GABA receptor agonist drug or anticholinergics or corticosteroids, or history of substance abuse or drug addiction. 7. Participation in any clinical trial within the past 3 months. 8. Severe systemic comorbidities (e.g., hepatic/renal failure, arrhythmias, organic heart disease). 9. Pregnant/lactating women or subjects (including males) planning pregnancy within 6 months. 10. Contraindications to taVNS, such as cardiac pacemakers, post-DBS surgery, or auricular pathologies (e.g., tympanic membrane perforation).

Outcomes

Primary Outcomes

Apathy Motivation Index (AMI)

The AMI is used to assess levels of apathy across behavioral, emotional, and cognitive domains. It provides a comprehensive measure of motivation deficits.

Time frame: baseline; 2 weeks; 6weeks; 8weeks; 10 weeks

Secondary Outcomes

Non-Motor Symptoms Scale, Second Version (NMSS-2)

The NMSS-2 is a comprehensive, clinician-administered tool designed to assess the range and severity of non-motor symptoms in individuals with Parkinson's disease. It covers multiple domains including sleep disturbances, mood, cognition, gastrointestinal symptoms, urinary dysfunction, and other non-motor manifestations. This second version of the scale provides an updated and refined assessment framework to capture the broad impact of non-motor symptoms on patients' quality of life.

Time frame: baseline; 2 weeks; 6weeks; 8weeks; 10 weeks

AMI subscales

AMI has three subscale dimensions including behavioral activation, social motivation and emotional sensitivity.

Time frame: baseline; 2 weeks; 6weeks; 8weeks; 10 weeks

Epworth Sleepiness Scale (ESS)

The ESS is a widely used self-assessment questionnaire designed to measure daytime sleepiness. It was developed by Dr. Murray Johns in 1991 and is commonly employed in clinical and research settings to evaluate excessive daytime sleepiness , which is often associated with sleep disorders like obstructive sleep apnea ,narcolepsy, or insomnia.