NonInvasive Brain Stimulation in Stroke Patients (RTNIBS)

March 27, 2015 updated by: NHS Greater Glasgow and Clyde

A Randomised Trial of Non-Invasive Brain Stimulation (NIBS) in Stroke Survivors

After a stroke affecting the right side of the brain, many patients are affected by "spatial neglect": the damage to the brain causes them to ignore the left side of their surroundings. At its most extreme they may be unaware that they have a left side, or believe that it is moving normally when it is in fact paralysed. In milder cases, people may be unable to recognise touch on the left side if their right side is also being touched, or objects in their left visual field if something is visible to their right. Neglect alters peoples' quality of life profoundly, often renders them more dependent on others to undertake basic activities of daily living, and makes effective rehabilitation much more difficult.

The limited success of current treatment approaches indicates gaps in understanding of the underlying mechanisms of neglect and its recovery. Recent data suggest that the problems in responding to the left side are a result of an imbalance of activity in those parts of the brain responsible for deciding which side to pay attention to. It might therefore be possible to help people with neglect by "rebalancing" the brain either by increasing activity in the damaged side, or alternatively by reducing activity in the undamaged side. In this pilot study, the investigators will test whether they can help by doing the second of these things.

The investigators propose to conduct a pilot clinical trial to explore whether using electric currents to temporarily modify the activity of specific areas of the intact side of the brain, influences recovery from neglect, when used either alone, or in combination with a training method that has previously appeared promising as a treatment. Brain activity will be modified using a technique called "transcranial direct current stimulation (tDCS)", in which small electric currents are applied to the scalp with a wire covered in damp cotton pads. This will be done over the specific parts of the brain that are responsible for focusing attention to one side.

The investigators will compare the clinical outcomes of four interventions (1: behavioural, 2: tDCS, 3: a combination of both and 4: control).

The investigators hope that these studies will advance their understanding of what treatments may help people with neglect, and how they might work.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Anticipated)

60

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.

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

18 years to 90 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Ischemic stroke affecting the right hemisphere, confirmed by CT or MRI.
  2. Persistent neglect for one month after ictus (confirmed by BIT).
  3. Prestroke functional independence (modified Rankin Scale score 0-2).
  4. Between 18-90 years of age

Exclusion Criteria:

  1. Patients younger than 18.
  2. Patients who do not understand verbal or written English (ie.need of translaters)
  3. bilateral infarcts (Confirmed by CT, MRI)
  4. Dementia (MOCA, Score <26).
  5. Neurological Disease (eg. Parkinson's Disease, epilepsy, MS)
  6. Significant morbidity (eg cancer, severe cardiac failure) likely to affect participation.
  7. Alcohol excess (more than 50/40 units a week for men/women respectively).
  8. Patients who fall under the exclusion criteria for TDCS which includes patients suffering from a stroke related seizure :

History of epilepsy, medications or psychoactive drugs that can lower seizure threshold [imipramine, amitriptyline, doxepine, nortriptyline, maprotiline, chlorpromazine, clozapine, foscarnet, ganciclovir, ritonavir, amphetamines, cocaine, (MDMA, ecstasy), phencyclidine (PCP, angel dust), ketamine, gammahydroxybutyrate (GHB), alcohol, theophylline]. Withdrawal from alcohol, barbiturates, benzodiazepines, meprobamate, chloral hydrate. Patients who are pregnant or have suffered from a stroke-related seizure.

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: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Action Training
Training exercise which involves patients lifting up rods of different sizes and shifting their grip if this is too far to one side
Other: Action Training
Experimental: tDCS
A constant 1mA current will be applied to the left (undamaged) side of the scalp with an electrode covered with a damp cotton pad (25 cm2). The current will be applied for 15 minutes per day, with a total of 10 sessions over 3 weeks.
Other: Transcranial direct current stimulation
Other Names:
  • tDCS
Experimental: Action Training + tDCs
This will involve the same procedure as in action training only but with tDCS applied for 15 minutes during the rodlifting.
Other: Transcranial direct current stimulation
Other Names:
  • tDCS
Other: Action Training
Placebo Comparator: Control training
For the control training, patients will be asked to simply reach for the right hand side of each rod with their right (unaffected) hand and lift it

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Change in Behavioural Inattention Test (BIT)
Time Frame: 6 months post intervention
6 months post intervention

Secondary Outcome Measures

Outcome Measure
Time Frame
Compliance as measured by adherence to task instructions (percentage of intervention sessions, BIT tests completed)
Time Frame: baseline
baseline
Compliance as measured by adherence to task instructions (percentage of intervention sessions, BIT tests completed)
Time Frame: 3 weeks
3 weeks
Compliance as measured by adherence to task instructions (percentage of intervention sessions, BIT tests completed)
Time Frame: 6 months
6 months
Retention Numbers
Time Frame: baseline
baseline
Retention Numbers
Time Frame: 3 weeks
3 weeks
Retention Numbers
Time Frame: 6 months
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

NHS Greater Glasgow and Clyde

Collaborators

University of Glasgow

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

March 1, 2015

Primary Completion (Anticipated)

June 1, 2018

Study Completion (Anticipated)

June 1, 2018

Study Registration Dates

First Submitted

March 10, 2015

First Submitted That Met QC Criteria

March 27, 2015

First Posted (Estimate)

March 30, 2015

Study Record Updates

Last Update Posted (Estimate)

March 30, 2015

Last Update Submitted That Met QC Criteria

March 27, 2015

Last Verified

March 1, 2015

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • GN13NE562

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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