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Parkinson DiseaseDyn-fMRI-PDNCT06240624

Mapping Levodopa Effects on Cortico-basal Ganglia Circuit Function in Parkinson's Disease

An observational study of Parkinson Disease, run by Danish Research Centre for Magnetic Resonance at 1 site in Denmark.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

Levodopa-induced dyskinesia (LID) in Parkinson's disease (PD) are involuntary movements caused by long-term treatment with dopaminergic replacement therapy (levodopa). During the cause of PD, most patients develop LID. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Parkinson Disease
How many people
75 participants
Where
1 siteDenmark
Study dates
15 Aug 2022to 31 Dec 2025
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Healthy volunteers, age- and sex-matched the PD groups

Who may be able to join

  • Aged 18 or more

Who cannot join

  • Pregnancy or breastfeeding
  • History of other neurologic or psychiatric disease
  • History of epilepsy or familiar dispositions of epilepsy
  • Pacemaker or other implanted metallic or electronic devices which contraindicate MRI or TMS of the brain
  • Claustrophobia

Trial locations and contacts

1 site in 1 country.

Denmark1 site
  • Danish Research Centre for Magnetic Resonance, Hvidovre Hospital

    Hvidovre, Danmark, 2650

Other trials in Denmark

About this study

Official title: Dynamic Brain Mapping of the Functional Effects of Levodopa on Multiple Cortex-basal Ganglia Circuits in Parkinson ́s Disease

Levodopa-induced dyskinesia (LID) in Parkinson's disease (PD) are involuntary movements caused by long-term treatment with dopaminergic replacement therapy (levodopa). During the cause of PD, most patients develop LID. In this study, the investigators plan to investigate how the cortico-basal-ganglia networks are affected in LID. The investigators will examine PD patients with and without LID as well as healthy age-matched controls using fMRI and PET. During the fMRI experiment, participants will perform a novel go-no task engaging both motor, emotional and reward brain networks. Patients will be scanned before and after intake of levodopa to study the dynamic effects of dopaminergic therapy. Furthermore, a dopamine transporter PET will be acquired to study the dopaminergic degeneration of the patients with PD.

Read the detailed description

BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease affecting the cortico-basal-ganglia network including dopaminergic degeneration. PD is treated with dopaminergic replacement therapy such as levodopa which is a natural precursor of dopamine. Unfortunately, most patients develop involuntary movements after many years of treatment which are called levodopa-induced dyskinesia (LID). Little is known about how brain networks are disturbed in LID. To investigate this, the investigators will conduct a multimodal characterization of PD patients with LID. Patients with and without LID will be studied using dynamic task-based fMRI to trace the levodopa-induced changes in functional brain activity and connectivity in the transition from the off-to-on medication state. For the task-based fMRI, the investigators will employ a novel experimental task that concurrently engages motor, emotional, and reward networks. Furthermore, the investigators will also map and quantify the dopaminergic presynaptic deficit using dopamine transporter (DAT) PET ([18F]PE2I-PET) to correlate the findings with MRI.

This study is part of a larger study of brain phenotyping PD (ADAPT-PD) with MRI.

AIM This sub-study aims to achieve a multimodal characterization of LID in PD using both fMRI and DAT PET. Furthermore, both motor, reward and emotional cortico-basal-ganglia networks will be investigated. The result of this study will lay the foundation of a future non-invasive brain stimulation study using transcranial magnetic stimulation (TMS) in PD.

HYPOTHESES

  1. Patients with LID will show increased responsiveness to an acute levodopa challenge which will lead to a stronger time-dependent increase in striato-cortical motor network activity (preSMA and putamen) during NoGo trials after levodopa intake compared to patients without LID (Herz et al., 2014).
  2. Patients with LID will show increased activity in the SMA and pre-SMA and less activity of the rIFG during movement (go responses) compared to patients without LID in the off-medication state (Cerasa et al., 2012).
  3. Patients with LID will show abnormal levodopa-induced, task-related connectivity between putamen and and M1 compared to patients without LID (Herz et al., 2015).
  4. Patients with LID will show decreased dopamine transporter activity in putamen compared to patients without LID (Hong et al. 2014).

The analysis regarding reward and emotional processing in patients with LID and the comparisons between fMRI and PET will be exploratory as no previous studies have been conducted.

RESEARCH PLAN For the sub-study, the investigators aim to recruit 25 PD patients with LID, 25 PD patients without LID, and 25 age-matched healthy controls.

Being tested
No intervention
Keywords
Levodopa-induced dyskinesia, Parkinson's disease, fMRI
Medical subject headings
Parkinson Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • No interventionOther

    No intervention will be given.

Study groups in NCT06240624
Study groupRoleWhat they receive
Patients with Parkinson's disease and Levodopa-induced dyskinesiaInclusion criteria: * Aged 18 or more * Clinically established or probable PD according to the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease * Peak-of-dose levodopa-induced dyskinesia * Stable antiparkinsonian medicine for 4 weeks * Signed informed consent Exclusion criteria: * Pregnancy or breastfeeding * History of other neurologic or psychiatric disease * Pacemaker or other implanted metallic or electronic devices which contraindicate MRI or TMS of the brain * Claustrophobia
Receives: Other: No intervention
Patients with Parkinson's disease without Levodopa-induced dyskinesiaInclusion criteria: * Aged 18 or more * Clinically established or probable PD according to the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease * No levodopa-induced dyskinesia * Stable antiparkinsonian medicine for 4 weeks * Signed informed consent Exclusion criteria: * Pregnancy or breastfeeding * History of other neurologic or psychiatric disease * Pacemaker or other implanted metallic or electronic devices which contraindicate MRI or TMS of the brain * Claustrophobia
Receives: Other: No intervention
Healthy controlsInclusion criteria: * Aged 18 or more * Age- and sex-matched the PD groups * Signed informed consent Exclusion criteria: * Pregnancy or breastfeeding * History of other neurologic or psychiatric disease * Pacemaker or other implanted metallic or electronic devices which contraindicate MRI or TMS of the brain * Claustrophobia
Receives: Other: No intervention

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percent Mean Change in Blood Oxygen-level Dependent (BOLD) Scores During Modified Go/No-Go Task

    For each participant and each run, we will create general linear models with 20 regressors of interest.

    The regressors are Motor: Right, Left, and No-Go trials Emotion: Happy, Neutral, Sad Reward: High/low reward, high/low loss All above regressors will be separately modeled for the high- and the low-reward context.

    We will add a linear time modulation to all regressors to model dynamic changes in activation over time.

    Measured: 4 task runs of 10 minutes each

  2. Peak force

    Measured with grip-force response. The data will be smoothed and normalized to the individual maximum voluntary contraction.

    Measured: 4 task runs of 10 minutes each

  3. Reaction time

    Measured with grip-force response.

    Measured: 4 task runs of 10 minutes each

  4. Maximum slope

    Maximum value of first derivative of grip-force curve. Measured with grip-force response. The data will be smoothed and normalized to the individual maximum voluntary contraction.

    Measured: 4 task runs of 10 minutes each

  5. Maximal negative slope

    Maximum negative value of first derivative of grip-force curve. Measured with grip-force response. The data will be smoothed and normalized to the individual maximum voluntary contraction.

    Measured: 4 task runs of 10 minutes each

  6. Parkinson's disease severity

    Total Unified Parkinson's Disease Rating Scale (UPDRS) score (sum of all 4 subscores listed below, range 0-199, higher values = worse outcome), UPDRS-1 (Cognitive and mental disease severity, range 0-16, higher values = worse outcome), UPDRS-2 (disease severity in relation to activities of daily living, range 0-52, higher values = worse outcome) and UPDRS-3 (Motor severity, range 0-108, higher values = worse outcome), UPDRS-4 (Complications of therapy, range 0-23, higher values = worse outcome) subscores. Measured while subjects are taking their usual medication.

    Measured: Baseline (normal medication)

  7. Motor disease severity

    Unified Parkinson's Disease Rating Scale (UPDRS)-3 subscore (Motor severity, range 0-108, higher values = worse outcome). Measured while subjects are taking their usual medication.

    Unified Parkinson's Disease Rating Scale (UPDRS)-3 subscore (Motor severity, range 0-108, higher values = worse outcome). Measured while subjects are taking their usual medication.

    Unified Parkinson's Disease Rating Scale (UPDRS)-3 subscore (Motor severity, range 0-108, higher values = worse outcome). Measured while subjects are taking their usual medication.

    Measured: Before and 30-60 minutes after 150 % of normal morning levodopa dose as Madopar Quick.

  8. Non-motor disease severity

    Total Non-Motor Symptom Scale (NMSS) score (range 0-360, higher values = worse outcome). Measured while subjects are taking their usual medication.

    Measured: Baseline

  9. Non-motor fluctuation severity

    Total Non-Motor Fluctuation Assessment (NoMoFA) score (range 0-84, higher values = more severe non-motor fluctuations). Measured while subjects are taking their usual medication.

    Measured: Baseline

  10. Modified Hoehn and Yahr Staging

    Modified Hoehn and Yahr Staging (Crude measure of disease severity, range 0-5, higher score = worse outcome). Measured while subjects are taking their usual medication.

    Measured: Baseline

  11. Schwab and England Activities of Daily Living Scale

    Schwab and England Activities of Daily Living Scale (Measure of ADL function, range 100-0%, higher score = better ADL function). Measured while subjects are taking their usual medication.

    Measured: Baseline

  12. Apathy

    Total Lille Apathy Rating Scale (LARS) score (range -36-36, higher score = higher degree of apathy).

    Measured: Baseline

  13. Depression

    Major Depression Inventory (MDI) score (range 0-50), higher score = higher degree of depression

    Measured: Baseline

  14. Impulsive-Compulsive Disorders (ICD)

    Questionnaire for Impulsive-Compulsive Disorders (QUIP) (range 0-112), higher score = higher degree of ICD

    Measured: Baseline

  15. Cognitive function

    The Montreal Cognitive Assessment (MoCA) (range 0-30), higher score = better cognitive performance

    Measured: Baseline

  16. Impulsivity

    Barratt Impulsiveness Scale (BIS-11) (range 30-120), higher score = higher level of impulsivity.

    Measured: Baseline

  17. Dyskinesia severity

    Unified Dyskinesia Rating Scale (UDysRS)

    Measured: Baseline (usual medication intake) as well as before and 30-60 minutes after 150 % of normal morning levodopa dose as Madopar Quick (range 0-104), higher score = higher dyskinesia severity

  18. Dopaminergic degeneration

    Dopamine transporter (presynaptic) binding in the basal ganglia is measured using Fluorine-18 N-(3-iodopro-2E-enyl)-2beta-carbomethoxy-3beta-(4'-methylphenyl) nortropane Positron Emission Tomography to

    Measured: Baseline

  19. Age

    Measured: Baseline

  20. Disease duration of Parkinson's disease

    Measured: Baseline

  21. Duration of levodopa-induced dyskinesia

    Measured: Baseline

  22. Medication

    Measured: Baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Feb 2024
  2. Study start15 Aug 2022
  3. Primary completion31 Dec 2025 (estimated)
  4. Study completion31 Dec 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case-control
Time perspective
Cross-sectional
Enrolment
75 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06240624
Sponsor's protocol ID
H-22010296
Acronym
Dyn-fMRI-PD
Status last verified
Mar 2025
First submitted
28 Sep 2023
Last updated
22 May 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

An observational study of Parkinson Disease, run by Danish Research Centre for Magnetic Resonance at 1 site in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 22 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percent Mean Change in Blood Oxygen-level Dependent (BOLD) Scores During Modified Go/No-Go Task (time frame: 4 task runs of 10 minutes each). The study lists 22 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 May 2025.

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