- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02370875
rTMS and Botulinum Toxin in Benign Essential Blepharospasm
September 12, 2023 updated by: University of Florida
Combined Effects of rTMS and Botulinum Toxin in Benign Essential Blepharospasm: A Novel Approach
Benign essential blepharospasm (BEB) is a functionally disabling focal dystonia.
Botulinum neurotoxin (BoNT) therapy is suboptimal in many BEB patients.
Repetitious transcranial magnetic stimulation (rTMS) therapy is a promising noninvasive therapy and has shown positive benefits in BEB.
rTMS therapy can be easily combined with BoNT injections to enhance the effects of BoNT in BEB.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
A two week course of rTMS therapy to achieve sustained benefits will be employed.
With standard BoNT treatment, the peak-dose benefits are seen at about 4-6 weeks after the administration of injections.
rTMS will be introduced during this peak-dose period (about 6 weeks after BoNT or T1).The effects of combined therapy at about 10 weeks after BoNT injections (T2) and at about 12 weeks after BoNT injections (T3) will be examined along with the physiological effects at these time points.
Study Type
Interventional
Enrollment (Actual)
12
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Florida
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Gainesville, Florida, United States, 32607
- Center for Movement Disorders and Neurorestoration
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
28 years to 73 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- subjects diagnosed with blepharospasm or cranio-cervical dystonia who receive BoNT therapy at the Center for Movement Disorders will be approached. The investigators will enroll only those subjects who report experiencing positive benefits with BoNT but lasting about 10 weeks or less.
Exclusion Criteria:
- pregnancy
- active seizure disorder
- significant cognitive impairment
- exposure to neuroleptics
- presence of a metallic body such as pacemaker, implants, prosthesis, artificial limb or joint, shunt, metal rods and hearing aid.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Real rTMS stimulation
Repetitious transcranial magnetic stimulation (rTMS) will be delivered using the Magstim RapidStim2 over each anterior cingulate cortex, using a figure-of-eight coil.
The investigators will apply rTMS with 0.2 Hz frequency to the ACC.
180 stimuli will be delivered with a stimulator output of 100% active motor threshold (AMT).
AMT will be assessed at the tibialis anterior muscle with the coil.
The AMT will be defined as the lowest stimulation intensity required to evoke a 150 μV potential in the target muscle.
To determine the stimulation site for ACC, the coil will be placed over Fz and then moved over the midline of the brain in 0.5-cm steps anteriorly, until the point of maximum motor evoked potential in the orbicularis oculi (OO) muscle.
The coil position will be marked on the skin.
These rTMS sessions will be repeated daily for 10 days.
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Application of repetitious transcranial magnetic stimulation (TMS) pulses using Magstim RapidStim2 to a specific brain target at predefined stimulation parameters.
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Sham Comparator: Sham rTMS Stimulation
During sham repetitious transcranial magnetic stimulation (rTMS), subjects will undergo the same procedure for identifying stimulus location as used in patients receiving real rTMS using the sham Magstim RapidStim2 coil.
This coil will be placed on the patient's head in an identical manner however will not be connected to the Magstim device.
Instead another coil will be connected to provide stimulation sound.
In each stimulation condition, the Magstim will be placed behind the patient and not visible to him or her.
Placebo sham coil which produces discharge noise and vibration similar to a real coil without stimulating the cerebral cortex.
During rTMS, all patients will continue to wear ear plugs as instructed during the real stimulation sessions.
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Same procedure as real rTMS without stimulating the cerebral cortex.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in JRS Severity Score
Time Frame: 2 weeks after rTMS
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The change in the score of the Jankovic Rating Scale subscore for severity.
Rated on a 5-point scale (0-4), where a higher score indicates higher severity of blepharospasm.
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2 weeks after rTMS
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Change in JRS Frequency Score
Time Frame: 2 weeks after rTMS
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The change in the score of the Jankovic Rating Scale subscore for frequency.
Rated on a 5-point scale (0-4), where a higher score indicates higher frequency of forced blinks in blepharospasm.
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2 weeks after rTMS
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Change in Number of Sustained Forced Eye Blinks
Time Frame: 2 weeks after rTMS
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A video recording (5 minutes) was scored by two blinded neurologists to count the number of sustained forced eye-blinks.
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2 weeks after rTMS
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Change in Duration of Forced Blinks
Time Frame: 2 weeks after rTMS
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A video recording (5 minutes) was scored by two blinded neurologists to count the duration of sustained forced eye-blinks.
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2 weeks after rTMS
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in CDQ-24 QOL Score
Time Frame: 2 weeks after rTMS
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Change in score of the Craniocervical dystonia questionnaire (CDQ-24), a self-reported questionnaire designed to evaluate the impact of dystonia on activities of daily living and quality of life.
The total CDQ-24 score can therefore range from 0 to 96, with higher scores meaning greater impairment due to dystonia.
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2 weeks after rTMS
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Change in CDQ-24 ADL Subscore
Time Frame: 2 weeks after rTMS
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Change in Actitivities of Daily Living (ADL) subscore of the Craniocervical dystonia questionnaire (CDQ-24), a questionnaire designed to evaluate quality of life outcomes for patients with dystonia.
The ADL subscore is obtained from 6 of the 24 questions.
Each question is rated on a 5-point scale (0-4), where a higher number indicates increasing severity of impairment for that daily activity due to dystonia.
The total ADL subscore takes the sum of the number from five questions (a value from 0 to 24), then linearly transforms that sum to a 0-100 scale, where a higher score means greater impairment in daily life.
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2 weeks after rTMS
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Change in Social Subscale of CDQ-24
Time Frame: 2 weeks after rTMS
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Change in the social subscore of the Craniocervical dystonia questionnaire (CDQ-24), a questionnaire designed to evaluate quality of life outcomes for patients with dystonia.
The social subscore is obtained from 4 of the 24 questions.
Each question is rated on a 5-point scale (0-4), where a higher number indicates increasing severity of social impairment due to dystonia.
The total social subscore can therefore range from 0 to 16, with higher scores meaning greater impairment of social activities.
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2 weeks after rTMS
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Aparna Wagle-Shukla, MD, University of Florida
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
February 1, 2015
Primary Completion (Actual)
May 1, 2017
Study Completion (Actual)
November 1, 2017
Study Registration Dates
First Submitted
February 10, 2015
First Submitted That Met QC Criteria
February 24, 2015
First Posted (Estimated)
February 25, 2015
Study Record Updates
Last Update Posted (Actual)
September 15, 2023
Last Update Submitted That Met QC Criteria
September 12, 2023
Last Verified
September 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 201400993
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
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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