iTBS Study for Depression in Patients With Multiple Sclerosis

November 21, 2020 updated by: Wei Qiu, Third Affiliated Hospital, Sun Yat-Sen University

Intermittent Theta Burst Stimulation (iTBS) for the Treatment of Depression in Patients With Multiple Sclerosis: a Randomized Controlled Study

Multiple sclerosis (MS) is a chronic and demyelinating disease of the central nervous system. It is one of the most common cause of neurological disability in young adults. Depression is a common symptom in MS patients, with lifetime prevalence rates going up to 50%. Depression not only reduces the response to treatment, delays the recovery of neurological function and social ability, but also significantly increases the risk of disability in patients with MS.

Transcranial magnetic stimulation (TMS) is a non-invasive method of brain stimulation that is based on electromagnetic induction. Intermittent theta burst stimulation (TBS), a newer form of rTMS, delivers 600 pulses in just 3 min, versus 37.5 min for conventional rTMS, but it has been shown to produce similar effects in patient with treatment-resistant depression.

To observe the effect and safety of iTBS on patients with MS and depression, we design a double-blind, randomized controlled study. Results of this research will inform on the efficiency of the TMS for the treatment of depression in MS patients, which will reduce the risk of disability and improve the quality of life.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Multiple sclerosis (MS) is a chronic and demyelinating disease of the central nervous system. It is one of the most common cause of neurological disability in young adults. Depression is a common symptom in MS patients, with lifetime prevalence rates going up to 50%. Depression not only reduces the response to treatment, delays the recovery of neurological function and social ability, but also significantly increases the risk of disability in patients with MS. It is worth noting that depression remains widely underdiagnosed and untreated in MS patients. The investigators aim to treat the depression in MS patients using a non-invasive method, which will help improve life quality and reduce the risk of disability in patients.

Transcranial magnetic stimulation (TMS) is a non-invasive method of brain stimulation that uses magnetic fields to stimulate nerve cells in brain. Repetitive TMS (rTMS) is usually applied in antidepressant-resistant depression. Furthermore, some clinical trials show that rTMS also significantly improve Parkinson's related depression and postpartum depression. Intermittent theta burst stimulation (TBS), a newer form of rTMS, delivers 600 pulses in just 3 min, versus 37.5 min for conventional rTMS, but it has been shown to produce similar effects in patient with treatment-resistant depression.

In this study, thirty patients who meet the criteria will be included. They will then be randomly assigned into the SHAM or iTBS group for the study intervention. Patients and outcome assessors will be masked to treatment allocation. SHAM or iTBS will be delivered to stimulate left dorsalateral prefrontal cortex (DLPFC). The protocol includes 600 pulses per session: triplet 50 Hz bursts, repeated at 5 Hz; 2 s on and 8 s off. Each patient will receive 2 sessions per day over a period of 10 days (total of 20 sessions). After the treatment phase, patients will be followed up once after two weeks. The presence and severity of side effects will be assessed by the physician from the Department of Neurology. Before and after the iTBS or SHAM intervention and after two weeks of follow-up, primary and secondary measurements will be performed.

Results of this study will inform on the efficiency of the TMS for the treatment of depression in MS patients, which will reduce the risk of disability and improve the quality of life.

Study Type

Interventional

Enrollment (Anticipated)

30

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 Contact

Study Contact Backup

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 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • 1) Age 18 to 65
  • 2) Male and female patients with clinically definite MS according to 2017 McDonald criteria
  • 3) EDSS 0 to 6
  • 4) Score between 11 and 30 on the Montgomery-Asberg Depression Rating Scale (MADRS) and stable antidepressants therapy > 1 months before enrollment and during the follow-up period
  • 5) Informed consent of patients

Exclusion Criteria:

  • 1) History of seizures (personal or family)
  • 2) Comedication with neuroleptics or tricyclic antidepressants
  • 3) bipolar disorder
  • 4) Presence of other diseases of the nervous system (history of stroke, brain injury, brain tumor, increased intracranial pressure)
  • 5) Significant neurologic, psychiatric, cardiovascular, hepatic, renal, gastrointestinal, metabolic, or other systemic comorbidities.
  • 6) History of drug or alcohol abuse
  • 7) Cardiac pacemakers
  • 8) Metal implants in the head
  • 9) Pregnancy

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: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: iTBS stimulation
iTBS stimulation to left dorsolateral prefrontal cortex (DLPFC), twice daily, 10 days
Device: intermittent theta burst stimulation using a MagPro X100
Patients randomized to receive iTBS in left dorsolateral prefrontal cortex, each treatment will consist of 600 stimuli (triplet 50 Hz bursts, repeated at 5 Hz; 2 s on and 8 s off; total duration of 3 min 12 s). Simulated iTBS will be administered using Magventure static cooling MCF-B65 coil.
Sham Comparator: sham iTBS stimulation
sham iTBS stimulation to left dorsolateral prefrontal cortex (DLPFC), twice daily, 10 days
Device: sham intermittent theta burst stimulation using a MagPro X100
Patients randomized to receive sham iTBS will undergo the same procedure to patients receiving real iTBS. Sham iTBS will be administered using Magventure static cooling MCF-P-B65 coil that shares the same mechanical outline and produces identical sound level to MCF-B65 coil without stimulating the cerebral cortex.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Montgomery-Asberg Depression Rating Scale (MADRS)
Time Frame: 0 (baseline), 10 days and 4 weeks
The MADRS is a 0-60 point scale to measure depression severity with a higher number indicating more severe depression. A score of 0-6 indicates symptoms absent, 7-19 indicates mild depression, 20-34 moderate, and > 34 severe.
0 (baseline), 10 days and 4 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Presence and changes in severity of side effects
Time Frame: 0 (baseline), 10 days and 4 weeks
Adverse events will be assessed by the physician from Department of Neurology weekly.
0 (baseline), 10 days and 4 weeks
Change in Beck Depressive Inventory (BDI)
Time Frame: 0 (baseline), 10 days and 4 weeks
BDI is a widely utilized to assess depression in MS patients. It is a 21-item self-reporting questionnaire for evaluating the severity of depression. The score range is 0-63 with higher scores indicating higher intensity.
0 (baseline), 10 days and 4 weeks
Change in 21-item Beck's Anxiety Inventory (BAI)
Time Frame: 0 (baseline), 10 days and 4 weeks
BAI is a self-report test for measuring anxiety severity and level. It contains 21 multiple-choice questions. The score range is 0-63 with higher scores indicating higher intensity.
0 (baseline), 10 days and 4 weeks
Change in Fatigue Severity Scale (FSS)
Time Frame: 0 (baseline), 10 days and 4 weeks
The FSS is a 9-item scale which measure the severity of fatigue and its effect on an individual's daily living and social participation. The total score ranges from 9 to 63, with a higher score indicate greater fatigue severity.
0 (baseline), 10 days and 4 weeks
Change in Pittsburgh Sleep Quality Index (PSQI)
Time Frame: 0 (baseline), 10 days and 4 weeks
PSQI is a self-rated questionnaire designed to evaluate overall sleep quality during the past month. Each of the questionnaire's 19 self-reported items belongs to one of seven subcategories: sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, degree of daytime dysfunction.
0 (baseline), 10 days and 4 weeks
Change in Expand Disability Status Scale (EDSS)
Time Frame: 0 (baseline), 10 days and 4 weeks
EDSS is a standardized method used to classify the severity and progression of multiple sclerosis. It provides a total score on a scale that ranges from 0 to 10.
0 (baseline), 10 days and 4 weeks
Change in Cortical silent period (CSP) duration
Time Frame: 0 (baseline), 10 days and 4 weeks
CSP duration will be measured by Magventure X100 + option.
0 (baseline), 10 days and 4 weeks
Change in short-interval intracortical inhibition (SICI)
Time Frame: 0 (baseline), 10 days and 4 weeks
SICI will be measured by Magventure X100 + option.
0 (baseline), 10 days and 4 weeks
Change in intracortical facilitation (ICF)
Time Frame: 0 (baseline), 10 days and 4 weeks
ICF will be measured by Magventure X100 + option.
0 (baseline), 10 days and 4 weeks
Changes in long-interval intracortical inhibition (LICI)
Time Frame: 0 (baseline), 10 days and 4 weeks
LICI will be measured by Magventure X100 + option.
0 (baseline), 10 days and 4 weeks
Change in slow-wave/fast-wave (theta/beta) ratio from resting-state electroencephalograph (EEG) recording
Time Frame: 0 (baseline), 10 days and 4 weeks
Resting-state EEG will be recorded by Nicolet EEG system.
0 (baseline), 10 days and 4 weeks
Serum biomarker
Time Frame: 0 (baseline), 10 days
Serum biomarker such as BDNF, TNF-alpha, IL-1 beta, S100 beta will be examined before and after TMS treatment.
0 (baseline), 10 days

Collaborators and Investigators

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

Sponsor

Third Affiliated Hospital, Sun Yat-Sen University

Investigators

  • Principal Investigator: Wei Qiu, MD/Ph.D, Third Affiliated Hospital, Sun Yat-Sen University
  • Principal Investigator: Liqing Wang, MD/Ph.D, Third Affiliated Hospital, Sun Yat-Sen University

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 (Anticipated)

December 1, 2020

Primary Completion (Anticipated)

September 1, 2022

Study Completion (Anticipated)

December 31, 2022

Study Registration Dates

First Submitted

August 2, 2020

First Submitted That Met QC Criteria

August 19, 2020

First Posted (Actual)

August 24, 2020

Study Record Updates

Last Update Posted (Actual)

November 24, 2020

Last Update Submitted That Met QC Criteria

November 21, 2020

Last Verified

November 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 02-113-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

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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