Randomized, Single-blind, Controlled Study of 40 Hz Flickering Stimulation for Insomnia and Other Non-motor Symptoms in Patients With Parkinson's Disease

Parkinson's disease (PD) is a common neurodegenerative disorder characterized by both motor and non-motor symptoms. Insomnia and other sleep disturbances are highly prevalent in PD and significantly impair quality of life, yet current pharmacological therapies are often insufficient and may produce adverse effects. There is a clear need for novel, non-pharmacological approaches to improve sleep in PD.

Gamma-band (around 40 Hz) neural oscillations are associated with cortical network activity and may influence sleep regulation, brain adenosine levels, and glymphatic clearance. Flicker light stimulation at 40 Hz has been shown in preclinical and early clinical studies to modulate gamma oscillations and related neurophysiological processes. Based on these findings, 40 Hz visual flicker stimulation may represent a promising, non-invasive strategy for improving insomnia and other non-motor symptoms in PD.

In this single-center, randomized, single-blind, controlled trial, approximately 30 patients with PD and clinically significant insomnia will be enrolled. Eligible participants will be randomly assigned to receive either 40 Hz flicker light stimulation or control light. Participants in the 40 Hz group will receive visual flicker stimulation at 40 Hz for 30 minutes every night at bedtime for 7 consecutive days, using a dedicated light device, in addition to their stable antiparkinsonian medication. Participants in the control group will receive non-40 Hz light of similar intensity and duration under otherwise identical conditions.

Clinical assessments will include PD-specific sleep scales, particularly the Parkinson's Disease Sleep Scale-2 (PDSS-2), general sleep questionnaires such as the Pittsburgh Sleep Quality Index (PSQI), and sleep diaries. Objective sleep parameters, including total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and number of nocturnal awakenings, will be obtained from polysomnography where applicable. Other non-motor symptoms may also be evaluated using standardized scales. Safety assessments will include monitoring of adverse events, vital signs, and visual or ophthalmic discomfort during and after stimulation.

The parent protocol, initially approved in 2022, included healthy volunteers and primary insomnia patients. The present registration focuses exclusively on the Parkinson's disease insomnia cohort introduced by later protocol amendments and does not include the non-PD cohorts.