An Early Phase 1 interventional study of NeuroPace® RNS® System in Post-Traumatic Stress Disorder, sponsored by VA Greater Los Angeles Healthcare System. Status unknown at 1 site in United States. Open to male participants aged 25 Years to 60 Years. Per ClinicalTrials.gov, last updated 2024-05-28.
Sponsored by VA Greater Los Angeles Healthcare System · Early Phase 1, Interventional, and Treatment
Post-traumatic stress disorder (PTSD) refractory to treatment is marked by failure of fear extinction and its biological substrate, amygdala reactivity to trauma reminders. Decades of research have clarified the neuronal mechanisms coordinating fear extinction and consolidation. Fear cells and extinction cells in the basolateral amygdala (BLA) alter their firing rate based on the nature of the stimulus and the influence from the medial prefrontal cortex (mPFC) and the ventral hippocampus (vHPC). Together, the BLA, mPFC, and the vHPC form an anxiety-processing network where the BLA links stimulus to emotion, the vHPC provides memory context, and the mPFC coordinates extinction or consolidation. Local field potential (LFP) recordings from the BLA have revealed specific signals that correspond to an enhanced fear state. Previous studies have shown that neuromodulation of the BLA can promote extinction in a rodent model and in a treatment-refractory PTSD patient. This action is likely carried by disrupting fear signals within the BLA; however, continuous neurostimulation may also disrupt normal function of the amygdala. The present application proposes to investigate the use of Responsive Neurostimulation (RNS, Neuropace) in six (6) veterans suffering from severe treatment-resistant PTSD. This dual-activity device will allow us to chronically record LFPs from the BLA under specific conditions such as fear conditioning, exposure to trauma reminders, and emotional memory encoding and retrieval. In addition, the neural activity will be captured during real-life symptoms of flashback and nightmares. These recordings will provide the specific electrophysiological biomarkers of hypervigilance and re-experiencing. The device will then be programmed to detect and treat these biomarkers with a pre-determined electrical pulse. The patients will be followed prospectively using psychological scales but also with functional neuroimaging and electroencephalograms. These modalities will be used to determine the extent of circuit engagement as a result of the therapy. By approaching PTSD from a fear processing mechanism perspective, our project will serve as a proof of concept for other circuit-based therapies in psychiatry. This proposal is a multi-departmental effort involving 11 investigators across 7 departments and requires a close collaboration between clinical and basic scientists. As a result, the findings underlying chronic recordings will bridge the basic science results from fear conditioning research to clinical neural processes in PTSD patients.
2,284 studies on the registry are indexed under Stress Disorders, Post-Traumatic; 557 are open to participants now.
This study's planned enrollment of 6 is below the median of 70 across 1,897 interventional studies indexed under Stress Disorders, Post-Traumatic.
Browse Stress Disorders, Post-Traumatic studies →VA Greater Los Angeles Healthcare System is the lead sponsor of 32 studies on the registry; 5 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
This study consists in only one arm. In this arm, the patients will undergo the placement of the RNS implant and the subsequent RNS programming to optimize the PTSD symptoms.
Device: NeuroPace® RNS® System
In this intervention, patients suffering from PTSD undergo a surgical procedure to implant the responsive neurostimulation device (RNS, NeuroPace). This procedure involves the placement of a depth lead bilaterally in the amygdala and hippocampus following a trans-occipital trajectory. The two leads are then connected to a pulse generator fixated to the skull. RNS is able to detect specific signals from the target and to respond with a programmed electrical stimulation. One month after the implantation of the system, the patients will undergo 3 tasks: a fear conditioning task, the international affective picture system and the subsequent memory recall paradigm. These tasks will yield electrophysiological biomarkers of arousal and re-experiencing. We will then program RNS to detect and respond to those biomarkers. The patients will be followed longitudinally for improvement and evidence of target engagement as seen on cerebral metabolism and global electroencephalography.
Spectral power analysis and oscillatory properties
This is associated with Specific Aim 1: To determine electrophysiological biomarkers of fear, extinction and PTSD symptoms. The metric for measurement will be Better Oscillation Detection (BOSC)
Time frame: Baseline
Spectral power analysis and oscillatory properties
This is associated with Specific Aim 1: To determine electrophysiological biomarkers of fear, extinction and PTSD symptoms. The metric for measurement will be Better Oscillation Detection (BOSC)
Time frame: through study completion, an average of 1 year
Cross-frequency coupling and power coherence comodulograms
This is associated with Specific Aim 1: To determine electrophysiological biomarkers of fear, extinction and PTSD symptoms. The metric for measurement will be modulation index.
Time frame: Baseline
Cross-frequency coupling and power coherence comodulograms
This is associated with Specific Aim 1: To determine electrophysiological biomarkers of fear, extinction and PTSD symptoms. The metric for measurement will be modulation index.
Time frame: through study completion, an average of 1 year
Region of Interest analysis (FDG PET)
This is associated with Specific Aim 2: To determine engagement of fear processing neural networks by neurostimulation. The metric for measurement will be Cerebral metabolic rate of glucose (CMRglc)
Time frame: Baseline
Region of Interest analysis (FDG PET)
This is associated with Specific Aim 2: To determine engagement of fear processing neural networks by neurostimulation. The metric for measurement will be Cerebral metabolic rate of glucose (CMRglc)
Time frame: After initial exposure session
Region of Interest analysis (FDG PET)
This is associated with Specific Aim 2: To determine engagement of fear processing neural networks by neurostimulation. The metric for measurement will be Cerebral metabolic rate of glucose (CMRglc)
Time frame: 12 months post-operatively
Alpha rhythm frequency (EEG)
This is associated with Specific Aim 2: To determine engagement of fear processing neural networks by neurostimulation. The metric for measurement will be frequency (Hertz)
Time frame: Baseline
Alpha rhythm frequency (EEG)
This is associated with Specific Aim 2: To determine engagement of fear processing neural networks by neurostimulation. The metric for measurement will be frequency (Hertz)
Time frame: monthly after implantation for the first year
Alpha rhythm frequency (EEG)
This is associated with Specific Aim 2: To determine engagement of fear processing neural networks by neurostimulation. The metric for measurement will be frequency (Hertz)
Time frame: quarterly during year 2-4
Source localization (EEG)
This is associated with Specific Aim 2: To determine engagement of fear processing neural networks by neurostimulation. The metric for measurement will be discrete dipole fitting.
Time frame: Baseline
Source localization (EEG)
This is associated with Specific Aim 2: To determine engagement of fear processing neural networks by neurostimulation. The metric for measurement will be discrete dipole fitting.
Time frame: through study completion, an average of 1 year
Clinician Administered PTSD Scale
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score.
Time frame: Baseline
Clinician Administered PTSD Scale
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score.
Time frame: monthly after implantation for the first year
Occurrence of adverse events
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by frequency/severity.
Time frame: through study completion, an average of 1 year
Psychological scales (HAMA)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Psychological scales (HAMA)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: monthly after implantation for the first year
Psychological scales (HAMA)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: every three months up to 48 months after baseline
Psychological scales (MADRS)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Psychological scales (MADRS)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: monthly after implantation for the first year
Psychological scales (MADRS)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: every three months up to 48 months after baseline
Psychological scales (YBOC)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Psychological scales (YBOC)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: monthly after implantation for the first year
Psychological scales (YBOC)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: every three months up to 48 months after baseline
Digit Span subtest
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Digit Span subtest
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Trail Making Test A and B
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Trail Making Test A and B
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Ruff Figural Fluency Test (RFFT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Ruff Figural Fluency Test (RFFT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Brief Visual Memory Test
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Brief Visual Memory Test
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Revised (BVMT-R)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Revised (BVMT-R)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
California Verbal Learning Test
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
California Verbal Learning Test
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Attention, Processing Speed and Memory: Wechsler Adult Intelligence Scale IV (WAIS-IV)143 - Digit Span subtest, Trail Making Test A and B, Ruff Figural Fluency Test (RFFT), Brief Visual Memory Test - Revised (BVMT-R), California Verbal Learning Test
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Attention, Processing Speed and Memory: Wechsler Adult Intelligence Scale IV (WAIS-IV)143 - Digit Span subtest, Trail Making Test A and B, Ruff Figural Fluency Test (RFFT), Brief Visual Memory Test - Revised (BVMT-R), California Verbal Learning Test
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Wechsler Adult Intelligence Scale IV (WAIS-IV)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Wechsler Adult Intelligence Scale IV (WAIS-IV)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Wechsler Test of Adult Reading
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Wechsler Test of Adult Reading
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Controlled Oral Word Association (COWAT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Controlled Oral Word Association (COWAT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Hooper Visual Organization Test (VOT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Hooper Visual Organization Test (VOT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Rey-Osterrieth Complex Figure Test (CFT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Rey-Osterrieth Complex Figure Test (CFT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Wisconsin Card Sorting Test (WCST)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Wisconsin Card Sorting Test (WCST)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Stroop Color and Word Test
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Stroop Color and Word Test
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Iowa Gambling Task (IGT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Iowa Gambling Task (IGT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Montreal Cognitive Assessment (MOCA)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
Montreal Cognitive Assessment (MOCA)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Frontal Systems/ Executive Functions: Wisconsin Card Sorting Test (WCST), Stroop Color and Word Test, Iowa Gambling Task (IGT)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Rey-15 Recognition test of Mental Effort
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Months 6, 12, 24 and 48
Rey-15 Recognition test of Mental Effort
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
SF-36V (quality of life)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: Baseline
SF-36V (quality of life)
This is associated with Specific Aim 3: To assess the efficacy and safety of BLA stimulation for treatment-resistant PTSD. This test will be measured by the score
Time frame: through study completion, an average of 1 year
Plan to share: Yes — The data obtained will be shared semi-annually. The data shared will include de-identified raw scores on the assessments, PET study analysis and safety data (adverse events, EEG findings). We will insure the accuracy of the data being shared and we will work with the NCDT staff in order to confirm that we are submitting the data appropriately. We will also comply with the NIH Public Access Policy during any publication related to this study.
Supporting information: Clinical study report
Time frame: The data will become available on a semiannual basis.
This study is status unknown, as verified in May 2024. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Stress Disorders, Post-Traumatic →
VA Greater Los Angeles Healthcare System