- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03105700
Low Frequency TMS for Depression in Epilepsy (LFTMS)
Safety and Feasibility of Accelerated Low-Frequency Transcranial Magnetic Stimulation for Medication-Resistant Depression in Patients With Epilepsy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a pilot study designed primarily to assess whether patients with epilepsy can safely tolerate low-frequency transcranial magnetic stimulation in an accelerated protocol to treat depression. The investigators aim to treat 12 patients with epilepsy and comorbid depression to receive a total of 15 hours of transcranial magnetic stimulation over 3 days at Dartmouth-Hitchcock Medical Center (DHMC). The investigators will assess safety of this protocol with regards to seizure frequency and other side effects of TMS treatment and the feasibility of using an accelerated protocol in this patient population. In addition to these primary aims, our secondary goal is to determine if dense array EEG can provide a useful biomarker for depression and its treatment in focal epilepsy. A structural and functional MRI will be obtained before treatment and a dense array EEG before and after TMS treatment to assess for changes in specific dense array EEG based biomarkers.
In addition to recruiting patients, the study staff will likewise request that family members or friends of the patient accompany the patient monitor him/her for increased seizure frequency. The recruited family member will bring the patient to the treatment and stay with the patient overnight at a local hotel and monitor for possible seizures or other adverse events of treatment. Family members will be instructed in seizure safety and be given emergency phone numbers to call if the patient is experiencing adverse effects of TMS.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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New Hampshire
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Lebanon, New Hampshire, United States, 03756
- Dartmouth Hitchcock Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18 or older
- Able and willing to provide informed consent.
- Diagnosis of epilepsy confirmed by the study neurologist (KB).
- English-speaking
- Not pregnant
- Able to safely undergo MRI (as assessed by MRI safety form).
- Have a family member or friend (proxy) who will be able to bring the patient to the hospital and serve as a safety monitor during stay in study hotel for two consecutive nights.
- Patients on stable doses of current antiepileptic and antidepressant medications for 1 month.
Exclusion Criteria:
- Significant cognitive impairment measured by the Montreal Cognitive Assessment (MOCA) <23.
- History of other major psychiatric disorders (e.g., schizophrenia, bipolar disorder, substance use disorder (except caffeine and nicotine) or presence of unstable medical comorbidities.
- Actively/imminently suicidal (QIDS item 12 score > 2 or Mini-International Neuropsychiatric Interview (MINI) Suicidality module score > 16)
- Greater than 10 seizures per week during 1 month prior.
- History of stroke, moderate-severe traumatic brain injury or other major neurological disorder.
- Any magnetic or implanted device that will interfere with ability to safely receive MRI and/or TMS treatment.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Low Frequency TMS Intervention
Patients will receive low-frequency TMS on an accelerated schedule over three consecutive days.
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Repetitive transcranial magnetic stimulation (TMS) is a focal, nonpharmacological, noninvasive method for stimulating the brain and modulating neural network activity.
To administer TMS, an electromagnetic coil is placed on the scalp, and uses electrical current to create magnetic fields that depolarize or hyperpolarize neurons in the brain.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Seizure Frequency Expressed as the Average Number of Seizures Experienced by All Participants and Recorded at Specified Time Points Throughout the Study.
Time Frame: Baseline, 1-week post-treatment, 1-month post-treatment, 6-month post-treatment follow-up
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The hypothesis is that TMS treatment will not produce serious adverse events defined as an increase in the average number of seizures across all participants.
This data is collected from the time of enrollment, and then at baseline, 1-week post treatment, 1-month post-treatment, and 6-month post treatment.
The seizures are reported directly by the participants during check-ins with the research staff at the study specified study timepoints.
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Baseline, 1-week post-treatment, 1-month post-treatment, 6-month post-treatment follow-up
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Percentage of Participants Who Complete the TMS Treatment
Time Frame: 15 one-hour sessions of TMS over 3 days
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The percentage of participants who completed the TMS treatment as measured by the total number of participants (expressed as percentage) who completed 15-hour sessions of TMS over 3 days.
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15 one-hour sessions of TMS over 3 days
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Number of Treatment-emergent Adverse Events as Measured by a Modified Systematic Assessment for Treatment Emergent Events (SAFTEE).
Time Frame: Day 1, 2, and 3 of TMS treatment
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The hypothesis is that TMS treatment will not be associated with a higher rate of adverse events as measured by a modified Systematic Assessment for Treatment Emergent Events (SAFTEE) given pre-TMS treatment and immediately post-TMS sessions.
SAFTEE is a tool used to assess participants' adverse events and is presented to all participants before and right after each TMS session.
The outcome is expressed as a total number of adverse events across all participants and all TMS treatment sessions.
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Day 1, 2, and 3 of TMS treatment
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Measuring Biomarker for Depression Using Dense-array EEG
Time Frame: Baseline, Post-TMS, 1-month and 6-month follow-up
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Examine the utility of dense-array electroencephalogram (EEG) as a biological marker (biomarker) of depression and response to treatment with low-frequency transcranial magnetic stimulation (TMS) in patients with Epilepsy.
The ratio of alpha power between the right and the left hemispheres is considered an EEG based biomarker for depression.
It is obtained by dividing alpha power from the right brain hemisphere divided by alpha power measured from the left brain hemisphere.
A ratio higher than 1 (1 infers that both sides of the brain are equal) correlates with depression.
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Baseline, Post-TMS, 1-month and 6-month follow-up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in Depression Severity Related to the Study Interventions.
Time Frame: 1-week post-treatment, 1-month post-treatment, 3-month post-treatment, and 6-month post-treatment follow-up
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Exploratory analyses will investigate changes in depression scores as a result of the study protocol and interventions.
Quick Inventory of Depressive Symptomology (QIDS) is a self-assessment questionnaire used in this study to measure participants' depression symptoms.
For Major Depressive Disorder scores of 0-5 indicate no depression, 6-10 indicates mild depression, 11-15 is moderate depression, 16-20 is severe depression, and 21-27 is very severe depression.
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1-week post-treatment, 1-month post-treatment, 3-month post-treatment, and 6-month post-treatment follow-up
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Collaborators and Investigators
Collaborators
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 (Actual)
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
- D16150
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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