- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03273270
Effects of Neuromodulation and Rehabilitation of the Locomotor Network in Freezing of Gait (TMS/FOG)
Freezing of gait (FoG) is a common and debilitating condition in Parkinson's Disease (PD) patients. FoG is described as an episodic inability to walk, which often triggers falls, hospitalization and is an important predictor of poor quality of life. As locomotor regions degenerate in PD, gait automaticity is impaired. Patients compensate by increasing volitional control of gait, however, this adaptation has been found to worsen FoG severity. We hypothesize that increased cortical control of gait is maladaptive, and therapies to improve gait automaticity will not be effective unless cortical control of gait is reduced. The long-term goal of this project is to develop a therapeutic approach for FoG that simultaneously reduces cortical control and increases automaticity of gait. The objective is to determine the locomotor network abnormalities responsible for FoG and demonstrate how neuromodulation and rehabilitation can modulate the network. The rationale of this study is that increased connectivity between brainstem locomotor regions and cortical structures represents increased cortical governance of gait, and it can be reversed by the proposed intervention. We will accomplish this by combining a course of inhibitory rTMS (1Hz) to the cortex (supplementary motor area) with a rehabilitation protocol designed to increase gait automaticity (dual task training). We have designed a study that will carefully assess the locomotor network of freezers with resting state functional, diffusion and interleaved TMS/BOLD MRI studies, before and after intervention. Behavioral measures including gait analysis, cognitive and motor assessments will also be conducted at baseline and post treatment. The study aims to determine the effects of our intervention on the locomotor network (assessed with imaging), as well as on FoG severity as quantified through multiple markers obtained through gait analysis. At the conclusion of the study we expect to have determined the network changes central to the pathophysiology of FoG, the effects of 1Hz rTMS + rehabilitation on this network, and on FoG severity.
The relevance of this study to public health is to develop a non-invasive effective therapeutic option for one of the most debilitating and untreatable conditions affecting the lives of one million Americans suffering from PD; freezing of gait.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
South Carolina
-
Charleston, South Carolina, United States, 29425
- Medical University of South Carolina
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Subjects meeting diagnostic criteria for PD and documented FoG
-
Exclusion Criteria:
- Subjects with contraindications to MRI, or TMS (no history of seizures, no metal implants in head, no pregnancy) dementia, or inability to complete the walk 30 feet in the off state without assistance will be excluded.
Study Plan
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: Active TMS
1 Hz repetitive transcranial magnetic stimulation
|
transcranial magnetic stimulation
|
Placebo Comparator: Sham TMS
No active stimulation
|
transcranial magnetic stimulation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Functional Connectivity to the Supplementary Motor Area.
Time Frame: pre and post intervention (within one week of completion)
|
Change (pre vs post intervention) in resting-state fMRI connectivity (fisher z-score) of the supplemental motor area (SMA).
A negative change score means there was a reduction in SMA connectivity pre to post intervention.
A positive change score means there was an increase in SMA connectivity pre to post intervention.
|
pre and post intervention (within one week of completion)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in New Freezing of Gait Questionnaire
Time Frame: pre and post intervention (within one week of completion)
|
The new freezing of gait questionnaire is a measure of freezing severity (total score range: 0-28) wherein higher scores represent worse freezing behavior.
The outcome measures represent the change in freezing of gait questionnaire score from pre to post intervention.
A larger, positive value represents a greater reduction in freezing severity and a better outcome.
|
pre and post intervention (within one week of completion)
|
Change in Dual Task Time to Turn Off
Time Frame: pre and post intervention (within one week of completion)
|
The time to turn around a cone (in seconds) while dual tasking (performing a serial 7s and/or every other letter of the alphabet task) was measured while participants were in the OFF state (off of their Parkinson's medication).
The assessment were performed pre to post intervention.
A greater reduction in time to turn (pre versus post interverntion) is represented by a larger positive number.
A larger reduction in time to turn represents a better outcome.
|
pre and post intervention (within one week of completion)
|
Collaborators and Investigators
Investigators
- Principal Investigator: Gonzalo Revuelta, DO, Medical University of South Carolina
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- TMS/FOG
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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.
Clinical Trials on Parkinson Disease With Freezing of Gait
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Anhui Medical UniversityRecruitingTranscranial Magnetic Stimulation | Freezing of GaitChina
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Anhui Medical UniversityRecruitingTranscranial Magnetic Stimulation | Freezing of GaitChina
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China Medical University HospitalMinistry of Science and Technology, TaiwanUnknownParkinson's Disease With Freezing of GaitTaiwan
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China Medical University HospitalNational Science Council, TaiwanWithdrawnParkinson's Disease | Parkinson's Disease With Freezing of GaitTaiwan
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zhangyuqingRecruitingFreezing of GaitChina
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University of TorontoRecruitingParkinson Disease | Freezing of Gait | Gait, UnsteadyCanada
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Medical University of South CarolinaCompletedParkinson's Disease | Freezing of GaitUnited States
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IRCCS Istituto delle Scienze Neurologiche di BolognaAzienda Ospedaliera Città della Salute e della Scienza di TorinoRecruitingParkinson Disease | Freezing of GaitItaly
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ASST Gaetano Pini-CTOFondazione IRCCS Policlinico San Matteo di Pavia; Grisons Foundation for Parkinson...TerminatedParkinson Disease | Freezing of GaitItaly
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