Modulation of GABA-A Receptors in Parkinson Disease-Transdermal Flumazenil Arm

  • STATUS
    Recruiting
  • participants needed
    30
  • sponsor
    Nicolaas Bohnen, MD, PhD
Updated on 19 February 2024
anxiety
antidepressants
antipsychotics
stroke
serum pregnancy test
spinal cord
positron emission tomography
anticholinergics
brain imaging
parkinson's disease
parkinsonism
cholinesterase inhibitors
modafinil
dementia
cochlear implant
trihexyphenidyl
benztropine

Summary

The arm of this study evaluates possible GABA-A receptor target engagement effects of the FDA-approved medication, transdermal flumazenil (added 4/2020, replaced clarithromycin), in the setting of Parkinson's disease. Half of the subjects will receive transdermal flumazenil for 7-10 days, and half will receive a placebo. [11C]Flumazenil GABA-A receptor PET imaging will be used to assess target engagement effects.

Description

This study focuses on neurochemical changes in the brain that occur in Parkinson's disease. In particular we will be looking a neurotransmitter called GABA. In some Parkinson's disease patients we see too much GABA activity in the brain. This target engagement study examines the target engagement effect of GABA-A receptor modulation by transdermal flumazenil (previously clarithromycin). [11C]-flumazenil Positron Emission Tomography (PET) imaging results will be used to assess for possible GABA-A receptor target engagement effects of transdermal flumazenil (previously clarithromycin).

Details
Condition Parkinson's Disease, Parkinson's Disease
Age 50years - 100years
Treatment Clarithromycin (Not used as of 4/2020), Placebo (Not used as of 4/2020), Transdermal flumazenil (Added 4/2020), Placebo (Added 4/2020)
Clinical Study IdentifierNCT03440112
SponsorNicolaas Bohnen, MD, PhD
Last Modified on19 February 2024

Eligibility

Yes No Not Sure

Inclusion Criteria

Parkinson's disease (PD): PD diagnosis will follow the UK Parkinson's Disease Society Brain Bank Research Center (UKPDSBRC) clinical diagnostic criteria for PD
Hoehn and Yahr stages 2-4
Absence of dementia confirmed by cognitive testing
Abnormal 11C-Dihydrotetrabenazine ([11c]-DTBZ) PET study to demonstrate nigrostriatal dopaminergic denervation

Exclusion Criteria

PD with Dementia (PDD) or dementia with Lewy bodies (DLB)
Other disorders which may resemble PD, such as vascular dementia, normal pressure hydrocephalus, multiple system atrophy, corticobasal ganglionic degeneration, or toxic causes of parkinsonism. Prototypical cases have distinctive clinical profiles, like early and severe dysautonomia or appendicular apraxia, which may differentiate them from idiopathic PD. The use of the UKPDSBRC clinical diagnostic criteria for PD will mitigate the inclusion of subjects with atypical parkinsonism
Subjects currently on benzodiazepine, GABAB-ergic medications (baclofen, tizanidine), modafinil, neuroleptic, anticholinergic (trihexyphenidyl, benztropine), or cholinesterase inhibitor drugs
Evidence of a mass lesion on structural brain imaging (MRI)
Participants in whom MRI is contraindicated including, but not limited to, those with a pacemaker, presence of metallic fragments near the eyes or spinal cord, chest, or cochlear implant
Severe claustrophobia precluding MR or PET imaging
Subjects limited by participation in research procedures involving ionizing radiation
Pregnancy (urine or serum pregnancy test within 48 hours of each PET session) or breastfeeding
History of seizures
Significant anxiety or history of panic disorder
History of recent suicide attempt or overdose of tricyclic antidepressants or other medications
History of transient ischemic attack (TIA) or stroke within the last year
History of systemic lupus erythematosis
Abnormal liver enzymes (AST or ALT) > 3 times upper limit of normal
History of atrial fibrillation
History of retinal branch artery occlusion
Active dermatitis inner forearms
Any other medical history determined by investigators to preclude safe participation
Additional Exclusion Criteria for Flumazenil sub-studies
Allergy to flumazenil
Significant liver disease
History of alcohol or other substance abuse within past two years
Subjects currently taking benzodiazepines
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