Low-frequency Transcranial Magnetic Stimulation To Enhance Motor Recovery In The Subacute Phase After Stroke

NCT ID: NCT01333579

Last Updated: 2013-09-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1

Total Enrollment

34 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-02-29

Study Completion Date

2012-12-31

Brief Summary

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Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere (UH) transiently improves motor function in patients in the chronic phase after stroke. The goal of this study is to investigate effects on motor recovery of low-frequency rTMS of the UH, administered in the subacute phase after stroke.

Detailed Description

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Stroke is a major cause of disability and worldwide. Hand motor impairment is frequent after stroke. Even mild impairments of the upper limb negatively impact disability and quality of life in these patients significantly contributes to disability. Therapeutic alternatives for hand motor rehabilitation are deeply needed.

Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential tool to improve hand motor performance after stroke. While high-frequency rTMS (HF-rTMS) often increases motor cortical excitability, LF-rTMS often has the opposite effect. Up-regulation of excitability in the affected hemisphere by HF-rTMS or down-regulation of the UH by LF-rTMS can restore the balance in inter-hemispheric inhibition and hence, facilitate movement of the paretic hand Both strategies, as well as the combination of both, have yielded encouraging results when applied in proof-of-principle, single-session studies to patients with mild hand motor impairment in the subacute and chronic stages after stroke. However, few rTMS studies included patients less than six months after stroke, and effects of LF-rTMS of the unaffected hemisphere in patients with severe motor impairment in the subacute phase have not been yet reported.

The investigators opted for a novel approach to enhance hand motor recovery, by examining feasibility, safety and preliminary efficacy of either active or sham LF-rTMS of the UH or sham rTMS as add-on therapies to outpatient customary rehabilitation, to patients with mild to severe hand paresis, within 5-45 days after unilateral ischemic stroke. The investigators hypothesize that, at this stage, LF-rTMS will be feasible even in patients with severe motor deficits, will have minimal adverse events and will enhance effects of customary rehabilitation on hand motor performance.

Conditions

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Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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Active rTMS

1Hz active rTMS delivered to the unaffected hemisphere

Group Type ACTIVE_COMPARATOR

Repetitive transcranial magnetic stimulation

Intervention Type OTHER

Repetitive transcranial magnetic stimulation, frequency of 1Hz, once a day for ten days.

Placebo rTMS

1Hz placebo rTMS delivered to the vertex

Group Type PLACEBO_COMPARATOR

Repetitive transcranial magnetic stimulation

Intervention Type OTHER

Repetitive transcranial magnetic stimulation, frequency of 1Hz, once a day for ten days.

Interventions

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Repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation, frequency of 1Hz, once a day for ten days.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* First-ever ischemic stroke in the internal carotid artery territory confirmed by CT or MRI, 5-45 days before, leading to contralateral hand weakness
* Age, 18-80 years

Exclusion Criteria

* Cardiac pacemaker
* Pregnancy
* Implantable medication pump
* Intracranial hypertension
* History of seizures
* Metal in the head
* Decompressive surgery
* Other neurological diseases
* Shoulder pain
* Joint deformity in the paretic upper limb
* Severe chronic disease such as end-stage cancer or end-stage renal failure
* Inability to provide informed consent due to severe language or cognitive impairment
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fundação de Amparo à Pesquisa do Estado de São Paulo

OTHER_GOV

Sponsor Role collaborator

University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Adriana Bastos Conforto

Professor and Neurologist, Neurostimulation Laboratory

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Adriana Conforto, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

HC/FMUSP/Fundação Faculdade de Medicina

Locations

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Laboratório de Neuroestimulação, HC/FMUSP

São Paulo, São Paulo, Brazil

Site Status

Countries

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Brazil

References

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Anjos SM, Cohen LG, Sterr A, de Andrade KN, Conforto AB. Translational neurorehabilitation research in the third world: what barriers to trial participation can teach us. Stroke. 2014 May;45(5):1495-7. doi: 10.1161/STROKEAHA.113.003572. Epub 2014 Mar 18.

Reference Type DERIVED
PMID: 24643406 (View on PubMed)

Other Identifiers

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NCT2006/55504-0

Identifier Type: -

Identifier Source: org_study_id