- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03544333
Boost rTMS for Auditory Verbal Hallucinations
Boost rTMS for AVH - Therapeutic Response and Neurobiological Prediction Markers in Auditory Verbal Hallucinations
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Auditory verbal hallucinations affect up to 70% of schizophrenia patients (Waters, 2012), yet, even extended antipsychotic medication does not ameliorate AVH in 20-30% of patients (Sukhwinder S Shergill et al., 2007) and is often accompanied by side effects (Leucht et al., 2009). Therefore, it is crucial to develop and assess promising potentially beneficial therapeutic options.
Non-invasive brain stimulation techniques like repetitive transcranial magnetic stimulation (rTMS) have been proposed to disrupt mechanisms in question. A number of meta-analyses (Aleman, Sommer, & Kahn, 2007; Demeulemeester et al., 2012; Freitas, Fregni, & Pascual-Leone, 2009; C. W. Slotema, Blom, van Lutterveld, Hoek, & Sommer, 2014; C. W. Slotema, Dirk Blom, Hoek, & Sommer, 2010; Tranulis, Sepehry, Galinowski, & Stip, 2008) found significant effect sizes ranging from 0.42 to 1.04 for 1Hz rTMS over the left temporo-parietal junction for the treatment of AVH. However, the majority of studies so far investigated the effects of rTMS in treatment resistant schizophrenia patients as an ad-on or second-line treatment.
No study to date has explored the effects of rTMS either as a first-line treatment or in the initial stage of the illness. This is surprising, considering the fact that rTMS is a safe treatment with minimal side-effects (Rossi, Hallett, Rossini, & Pascual-Leone, 2009) that could be used already in the earlier phase of treatment. This stands in considerable contrast to the range of side-effects associated with antipsychotics (Leucht et al., 2017) that can be disabling for patients and lead to lower quality of life.
Therefore, the crucial next step is (1) to explore the effects of rTMS in medication-free patients from the whole schizophrenia spectrum and (2) to use an accelerated protocol of multiple rTMS-sessions within a short period of time. To make this assessment feasible, considering that patients have to be off medication, the safest and also most efficient way is an accelerated rTMS protocol. The great advantage of such an approach is that the effects of rTMS can be investigated independently of potentially influencing effects of antipsychotics and at the same time assess the efficacy of rTMS within a very short amount of time.
In the proposed study, the investigators aim to determine the efficacy of rTMS as a potential treatment for AVH in schizophrenia and thus reduce suffering in patients and their relatives.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
New York
-
Manhasset, New York, United States, 11004
- The Zucker Hillside Hospital, Northwell Health
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Provision of signed and dated informed consent form
- Stated willingness to comply with all study procedures and availability for the duration of the study
- Male or female, aged 18 to 65
- Diagnosed with Diagnostic and Statistical Manual (DSM) V diagnosis of schizophrenia (295.90), schizoaffective disorder (295.70), or brief psychotic disorder (298.80), prone to AVH in the acute phases of the disorder
- Willing to adhere to the rTMS regimen
- No antipsychotic medication in the last two weeks prior to the start of the study as well as no antipsychotic medication during participation in the study
- Agreement to adhere to Lifestyle Considerations throughout study duration
Exclusion Criteria:
- Current use of antipsychotic medication within the last 2 weeks
- Electroconvulsive therapy or rTMS within three months (see the TMS screening questionnaire)
- History of seizures
- Presence of implanted electronic device or metal implant in the head and neck region (DBS, cochlear implant, etc.)
- Pregnancy, as assessed with a pregnancy test prior to every MRI measurement, or lactation
- Any active general medical condition or central nervous system disease which can affect cognition or response to treatment
- Treatment with another investigational drug or other intervention within 2 weeks
- Current diagnosis of delirium, dementia, or amnestic amnesiac disorder; Diagnosis of mental retardation; Current (within the past three months) diagnosis of active substance dependence, or active substance abuse within the past week as indicated by self-report.
- Patients who are cognitively impaired and are thus not able to give informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: TRIPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: real transcranial magnetic stimulation
In the treatment arm, patients will receive 1Hz of repetitive transcranial magnetic stimulation (rTMS) over the left Sylvian parietal temporal area (area Spt) four times on 1 day (1 pulse/second and a total of 1'000 pulses: 16 minutes' protocol at 100 % of motor threshold modified based on Hoffman et al.,1999).
Area Spt will be localized via baseline structural imaging and our Localite TMS navigation system.
|
We will assess safety and efficacy of the following protocol: 1Hz of rTMS over the Sylvian parietal temporal area (area Spt) four times on 1 day (1 pulse/second and a total of 1'000 pulses: 16 minutes' protocol at 100 % of motor threshold modified based on Hoffman et al., 1999).
Area Spt will be localized via baseline structural imaging and our Localite TMS navigation system.
|
PLACEBO_COMPARATOR: sham transcranial magnetic stimulation
In the comparator arm, patients will receive no stimulation.
The TMS coil adjusted to the patients head will not be plugged into the TMS machine and can thus not have an effect on the brain.
Yet, patients will hear the same noises from a coil that is plugged in, see the TMS machine running, and area Spt localized via baseline structural imaging and our Localite TMS navigation system.
|
We will assess safety and efficacy of the following protocol: 1Hz of rTMS over the Sylvian parietal temporal area (area Spt) four times on 1 day (1 pulse/second and a total of 1'000 pulses: 16 minutes' protocol at 100 % of motor threshold modified based on Hoffman et al., 1999).
Area Spt will be localized via baseline structural imaging and our Localite TMS navigation system.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy of Transcranial Magnetic Stimulation for Auditory Verbal Hallucinations Assessed With the Hallucination Change Scale
Time Frame: Four timepoints of the Hallucination Change Scale (after every TMS session). Here, score after final session is reported.
|
Examine change in AVH severity, measured with the Hallucination Change Scale, due to low-frequency rTMS. The Hallucination Change Scale is a self-rating assesses severity of hallucinations. It is anchored at baseline using the patient's description of AVH for the previous 24-hours which is assigned a score of 10. The subsequent assessments are in relation to the baseline where a reduction of AVH relates to a value < 10 (best being a value of 0) and a worsening of AVH relates to a value > 10 (twice as severe as baseline being a value of 20). |
Four timepoints of the Hallucination Change Scale (after every TMS session). Here, score after final session is reported.
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Philipp Homan, MD PhD, Zucker Hillside Hospital, New York City, USA.
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
- 18-0024
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 Schizophrenia
-
Organon and CoCompletedSchizophrenia, Paranoid | Schizophrenia, Disorganized | Schizophrenia, Undifferentiated
-
Organon and CoCompletedSchizophrenia, Paranoid | Schizophrenia, Disorganized | Schizophrenia, Undifferentiated
-
Bradley LegaRecruiting
-
All India Institute of Medical Sciences, BhubaneswarRecruitingTreatment Resistant SchizophreniaIndia
-
King's College LondonSouth London and Maudsley NHS Foundation TrustRecruitingTreatment-resistant Schizophrenia | Healthy Controls | Treatment-responsive SchizophreniaUnited Kingdom
-
University of Sao PauloUnknownRefractory Schizophrenia | Super Refractory SchizophreniaBrazil
-
Peking UniversityNot yet recruitingTreatment-resistant Schizophrenia
-
Ohio State UniversityRecruitingTreatment-resistant SchizophreniaUnited States
-
University Hospital, BrestRecruitingSchizophrenia | Schizophrenia Prodromal | Schizophrenia, ChildhoodFrance
-
NYU Langone HealthNot yet recruitingTreatment-resistant SchizophreniaUnited States
Clinical Trials on transcranial magnetic stimulation
-
State University of New York - Upstate Medical...RecruitingHeadache | Brain Concussion | Mild Traumatic Brain Injury | Post-Concussion SymptomsUnited States
-
George Mason UniversityMedStar National Rehabilitation NetworkCompletedStroke | Stroke, Ischemic | Hemiparesis | Cerebral Vascular AccidentUnited States
-
Russian Academy of Medical SciencesCompletedStrokeRussian Federation
-
Centre hospitalier de l'Université de Montréal...Canadian Institutes of Health Research (CIHR)RecruitingMajor Depressive DisorderCanada
-
University Hospital TuebingenFederal Ministry of Health, Germany; University of Ulm; Department of Psychiatry... and other collaboratorsRecruitingMajor Depressive DisorderGermany
-
VA Office of Research and DevelopmentRecruitingDepression | Gulf War IllnessUnited States
-
National Institute of Mental Health (NIMH)CompletedHealthy VolunteersUnited States
-
University of ManitobaManitoba Medical Service FoundationSuspendedObsessive Compulsive DisorderCanada
-
Beth Israel Deaconess Medical CenterNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Completed
-
VA Office of Research and DevelopmentBrown University; VA Palo Alto Health Care SystemActive, not recruiting