Identification of Optimal Stimulation Site for Cervical Dystonia Symptoms: An Exploratory Study

NCT ID: NCT01859247

Last Updated: 2016-07-28

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

8 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-03-31

Study Completion Date

2014-06-30

Brief Summary

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The overall objective of this application is to therapeutically target the dysfunctional premotor-motor interaction in dystonia-and to provide a focused treatment of specific anatomical networks in order to reduce side effects and to improve symptom control over conventional therapies.

Detailed Description

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We propose using repetitive transcranial magnetic stimulation (rTMS) over distinct premotor areas in patients with cervical dystonia (CD) with the goal of improving symptoms and reducing unwanted side effects. The knowledge gained in this proposed research will identify a specific premotor area to be targeted with rTMS that is expected to result in a novel intervention that could enhance or replace current treatments for CD. rTMS could be included as an adjunct treatment to botulinum toxin that could sustain treatment effect and decrease the frequency of re-injection, potentially resulting in cost savings without a decrease in symptom control. In addition to medical cost reduction, improved quality of life could be expected with the successful development of therapies that extend dystonia symptom control. rTMs has been FDA-approved for the treatment of depression and our proposal uses an even lower stimulation rate, suggesting continued use within clearly safe parameters. Successful completion of this research could lead to rapid adoption of this therapeutic modality.

We will test the hypothesis that rTMS of a distinct premotor site will provide more effective treatment of CD than non-specific activation of the entire premotor region. This will be done by performing a randomized, observer-blinded exploratory pilot study to determine the optimal site of rTMS over various sites of the premotor and motor cortex to improve the symptoms of cervical dystonia. Completion of this aim should lead to development of targeted TMS therapy for CD.

Conditions

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Cervical Dystonia Spasmodic Torticollis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Dorsal Premotor rTMS

0.2 Hz rTMS for 15 minutes

Group Type ACTIVE_COMPARATOR

rTMS

Intervention Type DEVICE

Primary motor cortex rTMS

0.2 Hz rTMS for 15 minutes

Group Type ACTIVE_COMPARATOR

rTMS

Intervention Type DEVICE

Supplemental Motor Area rTMS

0.2 Hz rTMS for 15 minutes

Group Type ACTIVE_COMPARATOR

rTMS

Intervention Type DEVICE

Anterior Cingulate rTMS

0.2 Hz rTMS for 15 minutes

Group Type ACTIVE_COMPARATOR

rTMS

Intervention Type DEVICE

Sham rTMS

0.2 Hz rTMS for 15 minutes

Group Type SHAM_COMPARATOR

rTMS

Intervention Type DEVICE

Interventions

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rTMS

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Clinical diagnosis of idiopathic cervical dystonia
* Age 18 years or older
* Normal findings in the medical history, physical and neurological examination, except for dystonia
* Last treatment with botulinum toxin more than two months ago

Exclusion Criteria

* History of seizure disorder
* Pregnancy- a pregnancy test will be performed for women of childbearing potential
* History of any other neurological disorders or conditions requiring the use of anti-depressants that are known to increase seizure threshold, neuroleptic medication, anticholinergic drugs and muscle relaxants
* History of neuroleptic medications/ prior use of neuroleptics
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Dystonia Coalition

OTHER

Sponsor Role collaborator

National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

National Institute of Neurological Disorders and Stroke (NINDS)

NIH

Sponsor Role collaborator

University Health Network, Toronto

OTHER

Sponsor Role collaborator

University of New Mexico

OTHER

Sponsor Role lead

Responsible Party

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Sarah Pirio Richardson

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sarah Pirio Richardson, MD

Role: PRINCIPAL_INVESTIGATOR

University of New Mexico

H.A. Jinnah, MD

Role: STUDY_DIRECTOR

Emory University

Locations

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University of New Mexico

Albuquerque, New Mexico, United States

Site Status

Countries

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United States

References

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Beck S, Houdayer E, Richardson SP, Hallett M. The role of inhibition from the left dorsal premotor cortex in right-sided focal hand dystonia. Brain Stimul. 2009 Oct;2(4):208-14. doi: 10.1016/j.brs.2009.03.004. Epub 2009 May 3.

Reference Type BACKGROUND
PMID: 20633420 (View on PubMed)

Breakefield XO, Blood AJ, Li Y, Hallett M, Hanson PI, Standaert DG. The pathophysiological basis of dystonias. Nat Rev Neurosci. 2008 Mar;9(3):222-34. doi: 10.1038/nrn2337.

Reference Type BACKGROUND
PMID: 18285800 (View on PubMed)

Lefaucheur JP, Fenelon G, Menard-Lefaucheur I, Wendling S, Nguyen JP. Low-frequency repetitive TMS of premotor cortex can reduce painful axial spasms in generalized secondary dystonia: a pilot study of three patients. Neurophysiol Clin. 2004 Oct;34(3-4):141-5. doi: 10.1016/j.neucli.2004.07.003.

Reference Type BACKGROUND
PMID: 15501683 (View on PubMed)

Murase N, Rothwell JC, Kaji R, Urushihara R, Nakamura K, Murayama N, Igasaki T, Sakata-Igasaki M, Mima T, Ikeda A, Shibasaki H. Subthreshold low-frequency repetitive transcranial magnetic stimulation over the premotor cortex modulates writer's cramp. Brain. 2005 Jan;128(Pt 1):104-15. doi: 10.1093/brain/awh315. Epub 2004 Oct 13.

Reference Type BACKGROUND
PMID: 15483042 (View on PubMed)

Pirio Richardson S, Tinaz S, Chen R. Repetitive transcranial magnetic stimulation in cervical dystonia: effect of site and repetition in a randomized pilot trial. PLoS One. 2015 Apr 29;10(4):e0124937. doi: 10.1371/journal.pone.0124937. eCollection 2015.

Reference Type DERIVED
PMID: 25923718 (View on PubMed)

Other Identifiers

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U54NS065701

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UNM 657

Identifier Type: -

Identifier Source: org_study_id

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