- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01000103
Using Repetitive Transcranial Magnetic Stimulation (rTMS) in the Rehabilitation of Chronic Spatial Neglect After Stroke (NEGLECT)
Using Repetitive Transcranial Magnetic Stimulation (rTMS) in the Rehabilitation of Chronic Spatial Neglect After Stroke: A Double Blind Study
Study Overview
Status
Intervention / Treatment
Detailed Description
Scientific aims and goals:
The long-term goal aim of this application is to provide evidence of the role of a non-invasive neuromodulation technique such as rTMS in the treatment of chronic neurological sequels generated after strokes in human patients. Such interventions are based in an "at will" modulation the level of activity in intact regions, resulting in an enhancement of excitatory projections or the suppression of inhibitory influences driven through spared connectivity. They result in activity increases of the stroke surviving neurons, allowing the re-emergence of function after brain damage. Such principles can be applied to different sorts of neurological sequels for which the underlying connectivity and its post-stroke status is well known. In this specific project, we propose the use of low frequency rTMS on the intact left posterior parietal cortex (in the intraparietal sulcus, IPS) to improve the symptoms of visuospatial neglect derived form right stroke injuries including the posterior parietal cortex. Such project is based in the interhemispheric rivalry hypothesis, according to which, spatial neglect is in part caused by the over inhibition exerted from the intact left parietal cortex onto the injured left homologue regions, which are mediated by well-known overall inhibitory transcallosal projections between the left and the right hemispheres. According to this hypothesis and preliminary data, the reduction of the left parietal disinhibition should result into a lesser degree of suppression exerted by the intact left hemisphere sites onto the right injured parietal areas, process which will along the emergence of activity.In this context, we defined a primary aim accompanied by two secondary aims, which will be tackled in parallel:Primary AIMS AIM1: To assess the effects of repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of chronic visuospatial neglect generated by stroke Secondary AIMS AIM 2: To assess the durability of such a recovery over time once the treatment is completed and discontinued AIM 3: To further assess the safety of such therapeutic approach based in the deactivation of an intact -but hyperexcited region- holding connectivity with the damaged area.
Evaluation criteria Main criteria -Changes in the Spatial Bias Compound Score (SBCS) between pre (baseline) and post 10 days of rTMS treatment Such score is calculated on the basis of the result of 4 subtests which include: (1) bells cancellation task, (2) a copy of the GAINOTTI figure, (3) identification of overlapping figures, and (4) line bisection, according to the following formula (SBCS=λ=ln(XR/XL), considering the identification or copying of elements presented on the right or the left visual fields of the patient. The subtests of the SBCS will be also individually assessed and followed.
Secondary criteria
- Efficacy criteria
- Safety criteria
- Predictive factors assessmentStudy population and duration of studyWe will study a population of stroke patients with chronic signs of hemispatial neglect with at least 3 months of evolution (n=148, 2 groups of 74 patients) recruited across 48 months at an approximate rate of 37 patients /year.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
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-
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Paris, France, 75013
- Hôpital de la Salpétrière
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Unilateral right hemisphere stroke
- Visuospatial neglect or extinction at the time of entry, as determined by at least 1 test of the battery (BEN) displaying pathological scores (cut off values as defined in AZOUVI et al. JNNP 2004, Table 1), or an ECB test, score > 8
- A period of evolution of at least 3 months since stroke event
- Age between 18 and 75 years old
- Affiliation to Social Security system
- Informed consent signature
Exclusion Criteria:
Criteria related to the stroke:
- Bilateral stroke lesions: left hemispheric focal lesion excluding leucoaraiosis or mild lesions of the white matter
Criteria related to rTMS:
- Metal in the head, or a history of prior neurosurgical procedures
- Ferromagnetic bioimplants activated by any electronic, mechanical or magnetic means such as: cochlear implants, pacemakers, medication pumps, vagal stimulators, deep brain stimulators, neurostimulators, bio stimulators, or ventriculoperitoneal shunts.
- Prior history of seizures or seizure events following the stroke requiring the use of antiepileptic drugs
- Pregnancy (by history or positive urine pregnancy test)
- A urine pregnancy test will be done on all women of childbearing potential (those who have started menstruating up until they have stopped menstruating) prior to each MRI session, to rule out pregnancy.
- Diagnosis of tinnitus
- Participation in any experimental neglect rehabilitation project for at least 5 weeks before and 2 weeks after the stimulation, or during the 6 months of follow-up.
- Prior participation in TMS based treatments or experiments
Criteria related to feasibility:
- Incapacity to follow and complete the stimulation and follow-up protocol
- Other medical cerebral conditions other than the condition studied in the present protocol
- Any general medical condition, which could potentially interfere with clinical progression
- Any incapacitating psychiatric conditions, including significant history of substance abuse and severe depression
- Chronic treatment with medications that might modify cortical excitability
- Subjects with visual impediments that would limit our ability to obtain reliable testing
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: 1: Real rTMS treatment
Transcranial Magnetic Stimulation, in a low frequency (1 Hz) continuous train of 20 minutes (1200 pulses)
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Transcranial Magnetic Stimulation, in a low frequency (1 Hz) continuous train of 20 minutes (1200 pulses)
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SHAM_COMPARATOR: 2: Sham rTMS treatment
Simulation of rTMS
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two TMS coils will be used: a passive one which is placed flat on top of the "actively" targeted region which remains unplugged and generates a continuous scalp tactile sensation, and an active one located at a prudential distance from the scalp, which will deliver active pulses and its accompanying sensations
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Changes in the Spatial Bias Compound Score (SBCS). Such score is calculated on the basis of the result of 4 subtests
Time Frame: between pre (baseline) and post 10 days of rTMS treatment
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between pre (baseline) and post 10 days of rTMS treatment
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Changes in Catherine BERGEGO Scale and-or equivalent ecological test
Time Frame: between pre (baseline) and every subsequent evaluation
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between pre (baseline) and every subsequent evaluation
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Changes in the percentage of correct target detections vs. total
Time Frame: between pre (baseline) and every subsequent evaluation
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between pre (baseline) and every subsequent evaluation
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Changes in the Normalized reaction time of correct detections
Time Frame: between pre (baseline) and every subsequent evaluation
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between pre (baseline) and every subsequent evaluation
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potential clinically relevant side-effect caused by the use of TMS in terms of neurological manifestations such as: seizure, occurrence of additional stroke, or signs of enhanced intracranial pressure.
Time Frame: During rTMS treatment and the 6 months follow-up
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During rTMS treatment and the 6 months follow-up
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changes in cognitive functions processed by the intact left parietal cortex
Time Frame: between baseline and every subsequent evaluation, during the 6 months follow-up
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between baseline and every subsequent evaluation, during the 6 months follow-up
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Changes of the main cognitive domains and depression status according to the Mini-Mental test and Hamilton depression scale
Time Frame: between pre (baseline) and every subsequent evaluation
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between pre (baseline) and every subsequent evaluation
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Correlation between treatment efficacy and lesion location and extent
Time Frame: Any time after the end of rTMS treatment
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Any time after the end of rTMS treatment
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Correlation between treatment efficacy and severity of Neglect and other associated clinical deficits
Time Frame: Any time after the end of rTMS treatment
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Any time after the end of rTMS treatment
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Correlation between treatment efficacy and rTMS parameters and patient's cortical excitability and sensations
Time Frame: Any time after the end of rTMS treatment
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Any time after the end of rTMS treatment
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Correlation between treatment efficacy and daily activities with potential impact on Neglect
Time Frame: Any time after the end of rTMS treatment
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Any time after the end of rTMS treatment
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Evaluation of SBCS and its subscores at each follow-up visits
Time Frame: 5 days, 10 days, 15 days, 20 days, 27 days, 40 days, 70 days, 130 days and 190 days after 1st rTMS session.
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5 days, 10 days, 15 days, 20 days, 27 days, 40 days, 70 days, 130 days and 190 days after 1st rTMS session.
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Changes in neurological conditions according to: Rankin, Barthel and NIH SS scores
Time Frame: Between baseline and every subsequent evaluation
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Between baseline and every subsequent evaluation
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Collaborators and Investigators
Investigators
- Study Director: Pascale PRADAT-DIEHL, MD-PhD, Assistance Publique - Hôpitaux de Paris
- Principal Investigator: Antoni VALERO-CABRE, MD-PhD, Centre National de la Recherche Scientifique, France
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- P071238
- ID RCB 2009-A00280-57 (OTHER: ID RCB 2009-A00280-57)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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