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Completed

NCT Number: NCT06242678

Evaluating Spinal Cord Stimulation for Stiff Person Syndrome

The purpose of this prospective pilot study is to gather preliminary evidence evaluating spinal cord stimulation (SCS) as a potential therapy for the treatment of rigidity and painful spasms in patients with stiff person syndrome (SPS), a rare autoimmune neurological condition. The hypothesis is that SCS-mediated clinical improvement occurs through multi-modal mechanisms of action targeting several components of neuronal inhibitory signaling pathways in the spinal cord.

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Key information

Conditions

Stiff-Person Syndrome Autoimmune Diseases Autoimmune Diseases of the Nervous System Central Nervous System Diseases Immune System Diseases Nervous System Diseases Neuromuscular Diseases Spinal Cord Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Atrium Health Wake Forest Baptist

Winston-Salem, North Carolina, 27157, United States

About this study

The hypothesis is that SCS-mediated clinical improvement occurs through multi-modal mechanisms of action targeting several components of neuronal inhibitory signaling pathways in the spinal cord.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Is 18 years of age or older at the time that the Informed Consent Form (ICF) is signed.
  • Has been clinically diagnosed with stiff person syndrome
  • Has clinical symptoms of muscle rigidity and spasms in the truncal (including abdominal, thoracic paraspinal, and pectoral) or proximal lower limb musculature
  • Has Cerebrospinal fluid (CSF) Anti-glutamic acid decarboxylase 65 (anti-GAD65) antibodies or serum anti-GAD65 antibodies present at any titer
  • Is currently trying or has tried in the past at least two conventional therapies with insufficient symptomatic relief or intolerable side effects (such as nonsteroidal anti- inflammatory drugs, topical patches/creams/gels/ointments, physical therapy, acupuncture, bracing, assistive devices, and lifestyle modification).
  • If taking oral medications, is willing to maintain a stable regimen for the duration of the study period.
  • Is cleared for an implantable medical device by licensed mental health provider.
  • Is an appropriate candidate for the surgical procedures required in this study based on clinical judgement of the study physician.
  • Is willing to and capable of giving written informed consent.
  • Is willing and able to comply with study-related requirements and procedures and attend scheduled visits.

Exclusion criteria

  • Is less than 18 years of age at the time at the time that the Informed Consent Form (ICF) is signed.
  • Has a Body Mass Index (BMI) > 45.
  • Has a history of spine surgery or is planning to receive a spinal injection or procedure while participating in the study, unless this procedure can be postponed until after study completion.
  • Has radiological findings or evidence of moderate to severe central spinal canal stenosis or neuroforaminal stenosis at any thoracic level or laterality.
  • Has radiological findings or evidence of moderate/severe central spinal canal stenosis at any cervical or lumbar level.
  • Has had an epidural steroid injection within 6 weeks of enrollment.
  • Has a history of infection of the spine within 6 months of enrollment.
  • Has received intravenous immunoglobulin therapy within 30 days or is unwilling to maintain a stable regimen (no change in dosage or frequency) during the study period.
  • Has a history of opioid misuse or current chronic opioid therapy.
  • Has evidence of a coagulation abnormality or low platelet count (<120,000) indicated on Complete Blood Count test at screening, or has a history of abnormal bleeding, or if unable to pause anticoagulation therapy in accordance with accepted guidelines for a spinal cord stimulator trial.
  • Has a current local infection at the anticipated surgical entry site, active systemic infection, or active malignancy.
  • Has a medical condition or pain in other area(s) not intended to be treated in this study, that could interfere with study procedures, accurate pain reporting, and/or confound evaluation of study endpoints, as determined by the Investigator (such as radicular pain, post-herpetic neuralgia, central canal stenosis of the cervical, thoracic or lumbar spine, critical limb ischemia due to peripheral vascular disease, or small vessel disease).
  • Has a history of untreated major depressive disorder, or history of any mental health disorder with psychotic features, such as schizophrenia.
  • Is pregnant (confirmed via pregnancy test) or plans on becoming pregnant during the study period.
  • Has had, within six months of enrollment, a significant untreated addiction to dependency producing medications, alcohol or illicit drugs.
  • Is concomitantly participating in another interventional clinical trial.
  • Is involved in an injury claim for a study-related chronic pain that is under current litigation.
  • Is a recipient of temporary Social Security Disability Insurance (SSDI) benefits due to study related chronic pain.
  • Has a pending or approved worker's compensation claim for study-related chronic pain.
  • Has low English language literacy interfering with the ability to complete study requirements.

Treatment and study plan

SCS trial lead

Device

placement of spinal cord stimulator trial leads to see if effective in the management of symptoms associated with stiff person syndrome

Primary outcomes

  1. Pain Scores

    Time frame: Baseline

    baseline pain will be measured on a 0-10 scale, with 10 being the worse level of pain, with improvement in pain level measured immediately prior to removal (kept in up to 10 days), with pain level reassessed at 14 days after trial leads removed to see if returned to baseline

  2. Pain Scores

    Time frame: Day 24

    baseline pain will be measured on a 0-10 scale, with 10 being the worse level of pain, with improvement in pain level measured immediately prior to removal (kept in up to 10 days), with pain level reassessed at 14 days after trial leads removed to see if returned to baseline

  3. Michigan Body map

    Time frame: baseline

    The Michigan Body Map (MBM) is a self-report measure to assess body areas of chronic pain with each area of pain marked is scored 1 point. Maximum score is 35.

  4. Michigan Body Map

    Time frame: up to day 10

    The Michigan Body Map (MBM) is a self-report measure to assess body areas of chronic pain with each area of pain marked is scored 1 point. Maximum score is 35.

  5. Penn Spasm Frequency and Severity Scale

    Time frame: Baseline

    The first component is a 5 point scale assessing the frequency with which spasms occur ranging from "0 = No spasms" to "4 = Spontaneous spasms occurring more than ten times per hour". The second component is a 3 point scale assessing the severity of spasms ranging from "1 = Mild" to "3 = Severe"

  6. Penn Spasm Frequency and Severity Scale

    Time frame: up to day 10

    The first component is a 5 point scale assessing the frequency with which spasms occur ranging from "0 = No spasms" to "4 = Spontaneous spasms occurring more than ten times per hour". The second component is a 3 point scale assessing the severity of spasms ranging from "1 = Mild" to "3 = Severe"

  7. Pain Disability Index

    Time frame: Baseline

    The Pain Disability Index (PDI) is a self-report questionnaire that measures the impact of pain on a person's life. The PDI is scored on a scale of 0 to 70, with higher scores indicating a greater degree of disability:

    0: No disability 10: Total disability

    The PDI is made up of seven items, each rated on a scale of 0 to 10:

    Family/home, Recreation, Social activity, Occupation, Sexual behavior, Self-care, and Life-support activity.

  8. Pain Disability Index

    Time frame: up to Day 10

    The Pain Disability Index (PDI) is a self-report questionnaire that measures the impact of pain on a person's life. The PDI is scored on a scale of 0 to 70, with higher scores indicating a greater degree of disability:

    0: No disability 10: Total disability

    The PDI is made up of seven items, each rated on a scale of 0 to 10:

    Family/home, Recreation, Social activity, Occupation, Sexual behavior, Self-care, and Life-support activity.

  9. Pittsburgh Sleep Quality Index (PSQI)

    Time frame: Baseline

    The component scores consist of subjective sleep quality, sleep latency (i.e., how long it takes to fall asleep), sleep duration, habitual sleep efficiency (i.e., the percentage of time in bed that one is asleep), sleep disturbances, use of sleeping medication, and daytime dysfunction. There are seven "component" scores, each of which has a range of 0-3 points. In all cases, a score of "0" indicates no difficulty, while a score of "3" indicates severe difficulty

  10. Pittsburgh Sleep Quality Index (PSQI)

    Time frame: up to Day 10

    The component scores consist of subjective sleep quality, sleep latency (i.e., how long it takes to fall asleep), sleep duration, habitual sleep efficiency (i.e., the percentage of time in bed that one is asleep), sleep disturbances, use of sleeping medication, and daytime dysfunction. There are seven "component" scores, each of which has a range of 0-3 points. In all cases, a score of "0" indicates no difficulty, while a score of "3" indicates severe difficulty

  11. Fatigue Severity Scale (FSS) scores

    Time frame: baseline

    The FSS is a nine-item questionnaire that uses a seven-point Likert scale to score responses. The scale ranges from 1, which means "strongly disagree," to 7, which means "strongly agree". The minimum score is 9 and the maximum score is 63. A higher score indicates more severe fatigue.

  12. Fatigue Severity Scale (FSS) scores

    Time frame: up to day 10

    The FSS is a nine-item questionnaire that uses a seven-point Likert scale to score responses. The scale ranges from 1, which means "strongly disagree," to 7, which means "strongly agree". The minimum score is 9 and the maximum score is 63. A higher score indicates more severe fatigue.

  13. Patient Health Questionnaire-Depression

    Time frame: baseline

    The Patient Health Questionnaire-8 (PHQ-8) is a self-reported scale that measures depressive symptoms over the previous two weeks. The PHQ-8 is scored by adding up the scores for each of the eight items, which range from 0 to 3. The response options for each item are:

    0: Not at all

    • Several days
    • More than half the days
    • Nearly every day

    The total score ranges from 0 to 24, with higher scores indicating more severe depressive symptoms. The PHQ-8's scoring categories are:

    0-4: No significant depressive symptoms 5-9: Mild symptoms 10-14: Moderate symptoms 15-19: Moderately severe symptoms 20-24: Severe symptoms A score of 10 or higher is considered major depression, and a score of 20 or higher is considered severe major depression

  14. Patient Health Questionnaire-Depression

    Time frame: up to day 10

    The Patient Health Questionnaire-8 (PHQ-8) is a self-reported scale that measures depressive symptoms over the previous two weeks. The PHQ-8 is scored by adding up the scores for each of the eight items, which range from 0 to 3. The response options for each item are:

    0: Not at all

    • Several days
    • More than half the days
    • Nearly every day

    The total score ranges from 0 to 24, with higher scores indicating more severe depressive symptoms. The PHQ-8's scoring categories are:

    0-4: No significant depressive symptoms 5-9: Mild symptoms 10-14: Moderate symptoms 15-19: Moderately severe symptoms 20-24: Severe symptoms A score of 10 or higher is considered major depression, and a score of 20 or higher is considered severe major depression

  15. Generalized Anxiety Disorder

    Time frame: baseline

    The GAD-7 is a screening tool that measures the severity of anxiety. It's scored by assigning points to the response categories of "not at all", "several days", "more than half the days", and "nearly every day". The total score ranges from 0 to 21.

    0-4: Minimal anxiety, no intervention required 5-9: Mild anxiety, monitoring and follow-up recommended 10-14: Moderate anxiety, education about symptoms and therapy services recommended 15-21: Severe anxiety, therapy and medication recommended

  16. Generalized Anxiety Disorder

    Time frame: up to day 10

    The GAD-7 is a screening tool that measures the severity of anxiety. It's scored by assigning points to the response categories of "not at all", "several days", "more than half the days", and "nearly every day". The total score ranges from 0 to 21.

    0-4: Minimal anxiety, no intervention required 5-9: Mild anxiety, monitoring and follow-up recommended 10-14: Moderate anxiety, education about symptoms and therapy services recommended 15-21: Severe anxiety, therapy and medication recommended

  17. EuroQOL (EQ-5D-5L)

    Time frame: Baseline

    An index value of 1 represents the best possible health state, while an index value of <0 (variable) represents the worst possible health state.

  18. EuroQOL (EQ-5D-5L)

    Time frame: up to Day 10

    An index value of 1 represents the best possible health state, while an index value of <0 (variable) represents the worst possible health state.

Sponsors and collaborators

Lead sponsor

Wake Forest University Health Sciences

Other

Registry information

Important dates

Study start
2024
Primary completion
2025
Study completion
2025
First posted
Feb 5, 2024
Registry last updated
Jan 29, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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