Personalized Non-invasive Neuromodulation by rTMS for Chronic and Treatment Resistant Catatonia

NCT ID: NCT03116425

Last Updated: 2022-04-20

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

17 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-04-24

Study Completion Date

2022-06-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Investigators hypothesize that personalizing rTMS targets using functional MRI will allow to improve symptoms of patients suffering from chronic catatonia.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Two dysfunctional networks or regions will be chosen (verum 1 and 2) based on their abnormal rCBF. In line with the symptoms, dorso-lateral prefrontal and premotor regions are expected to be chiefly concerned. A normal region regarding its rCBF will be used as placebo. Targets will be stimulated using intermittent or continuous theta-burst according to the rCBF anomaly as an attempt to "normalize" their activity. The coil will be positioned using a robotic device under the control of a neuronavigation system in order to deliver a homogeneous stimulation. Using a balanced blinded randomized cross-over design, patients will be stimulated on 5 consecutive days (4 sessions per day) and evaluated pre-, post-stimulation and 1 month after. In this pilot study the primary outcome measures will be the clinical global impression scale whereas MRI will insure that stimulations achieved the correction of the rCBF anomalies. Secondary outcome measures will include personalized target symptom scales, and scales for catatonic, apathic and obsessive-compulsive symptoms.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Schizophreniform Catatonia Treatment Resistant

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Verum 1 - Premotor

The target region will be defined by comparing the rCBF scan of the patient to a control population (n = 38). rCBF will be measured using the QUIPS2 arterial spin labeling sequence on a Siemens 3T Verio.

The network including the premotor region will be targeted. The therapeutic protocol will be design to correct the rCBF anomaly.

Group Type EXPERIMENTAL

Individualized rTMS on VERUM 1's region or network

Intervention Type DEVICE

To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

Patients will have 4 sessions per day on 5 successive days per arm.

Individualized rTMS on VERUM 1's region or network

Intervention Type PROCEDURE

To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

Patients will have 4 sessions per day on 5 successive days per arm.

Verum 2 - Prefrontal

The target region will be defined by comparing the rCBF scan of the patient to a control population (n = 38). rCBF will be measured using the QUIPS2 arterial spin labeling sequence on a Siemens 3T Verio.

The network including the prefrontal region will be targeted. The therapeutic protocol will be design to correct the rCBF anomaly.

Group Type EXPERIMENTAL

Individualized rTMS on VERUM 2's region or network

Intervention Type DEVICE

To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

Patients will have 4 sessions per day on 5 successive days per arm.

Individualized rTMS on VERUM 2's region or network

Intervention Type PROCEDURE

To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

Patients will have 4 sessions per day on 5 successive days per arm.

Placebo

Stimulation of a region with normal rCBF and putatively unrelated to catatonic symptoms (parietal cortex).

Group Type ACTIVE_COMPARATOR

Individualized rTMS on PLACEBO region

Intervention Type DEVICE

Region will be modulated up or down according to the stimulation protocol used in VERUM 1 and 2 conditions.

Stimulation will be replicated up to 5 times per session. Patients will have 4 sessions per day on 5 successive days per arm.

Individualized rTMS on PLACEBO region

Intervention Type PROCEDURE

Region will be modulated up or down according to the stimulation protocol used in VERUM 1 and 2 conditions.

Stimulation will be replicated up to 5 times per session. Patients will have 4 sessions per day on 5 successive days per arm.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Individualized rTMS on VERUM 1's region or network

To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

Patients will have 4 sessions per day on 5 successive days per arm.

Intervention Type DEVICE

Individualized rTMS on VERUM 2's region or network

To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

Patients will have 4 sessions per day on 5 successive days per arm.

Intervention Type DEVICE

Individualized rTMS on PLACEBO region

Region will be modulated up or down according to the stimulation protocol used in VERUM 1 and 2 conditions.

Stimulation will be replicated up to 5 times per session. Patients will have 4 sessions per day on 5 successive days per arm.

Intervention Type DEVICE

Individualized rTMS on VERUM 1's region or network

To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

Patients will have 4 sessions per day on 5 successive days per arm.

Intervention Type PROCEDURE

Individualized rTMS on VERUM 2's region or network

To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

Patients will have 4 sessions per day on 5 successive days per arm.

Intervention Type PROCEDURE

Individualized rTMS on PLACEBO region

Region will be modulated up or down according to the stimulation protocol used in VERUM 1 and 2 conditions.

Stimulation will be replicated up to 5 times per session. Patients will have 4 sessions per day on 5 successive days per arm.

Intervention Type PROCEDURE

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

Putative premotor region or network Putative prefrontal region or network (One per line) Putative premotor region or network Putative prefrontal region or network

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Aged from 18 to 70 Y
* Affiliated to the health insurance
* Having signed an informed consent
* Suffering from catatonia according to the DSM5, unremitted since \> 2Y
* Unresponsive or incomplete remission after at least one trial of benzodiazepine and/or Electroconvulsivotherapy
* Treatment stable for \> 6 weeks

Exclusion Criteria

* Contraindication for MRI, rTMS or tDCS: non-removable ferromagnetic body, prosthesis, pacemaker, medication delivered by an implanted pump clip or vascular stent, heart valve or ventricular shunt, seizure disorders, skin pathology in the region of tDCS electrode placement.
* Pregnancy
* Severe and non-stabilized somatic pathology
* Patients deprived of liberty or hospitalized without their consent
* Patients unable to give informed consent.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University Hospital, Strasbourg, France

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Jack FOUCHER, MD

Role: PRINCIPAL_INVESTIGATOR

Hôpitaux Universitaires de Strasbourg

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

CEMNIS

Strasbourg, , France

Site Status

Countries

Review the countries where the study has at least one active or historical site.

France

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

6441

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

rTMS and Functional Paralysis
NCT01352910 COMPLETED NA