Transcranial Magnetic Stimulation in Stroke Motor Rehabilitation Treatment

NCT ID: NCT03268070

Last Updated: 2025-08-28

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: NA
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-03-31
• Study Completion Date: 2027-02-28

Brief Summary

The goal of the study is to determine the effect of repetitive transcranial magnetic stimulation (rTMS) over the premotor cortex on training-related improvements in motor performance and associated neural plasticity.

Detailed Description

Occlusion of the middle cerebral artery is the most common cause of stroke. Because the middle cerebral artery supplies blood to the motor cortices, middle cerebral artery stroke often impacts the integrity of the motor cortex and its associated corticospinal projections. Less than half of all individuals post-stroke regain complete motor function. Because motor deficits, especially of the upper extremities, can dampen the quality of life, there is an urgent need to improve current rehabilitation programs to allow more stroke survivors to achieve higher functional gains.

Motor training is an important part of recovery after stroke. During motor training, patients practice performing a movement and become better at performing the trained movement over time. Repetitive transcranial magnetic stimulation (rTMS), which uses magnetism to excite neurons near the surface of the brain, may further improve performance. There is evidence that the premotor cortex may be a more effective target than the primary motor cortex for rTMS for some stroke survivors. In the current study, the investigator will determine the effect of rTMS over the premotor cortex on training-related improvements in motor performance in adults who experienced a stroke more than 6 months ago.

Conditions

Stroke

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Repetitive TMS over contralateral premotor cortex

Location of repetitive Transcranial Magnetic Stimulation (rTMS): contralateral premotor cortex.

Group Type: EXPERIMENTAL

Repetitive TMS over contralateral premotor cortex.

Intervention Type: DEVICE

Repetitive Transcranial magnetic stimulation (rTMS) will be applied over contralateral premotor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.

Repetitive TMS over ipsilateral premotor cortex

Location of repetitive Transcranial Magnetic Stimulation (rTMS): ipsilateral premotor cortex.

Group Type: EXPERIMENTAL

Repetitive TMS over ipsilateral premotor cortex.

Intervention Type: DEVICE

Repetitive Transcranial magnetic stimulation (rTMS) will be applied over ipsilateral premotor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.

Repetitive TMS over contralateral primary motor cortex

Location of repetitive Transcranial Magnetic Stimulation (rTMS): contralateral primary motor cortex.

Group Type: EXPERIMENTAL

Repetitive TMS over contralateral primary motor cortex.

Intervention Type: DEVICE

Repetitive Transcranial magnetic stimulation (rTMS) will be applied over contralateral primary motor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain.Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.

Sham repetitive TMS over contralateral premotor cortex

Location of Sham repetitive Transcranial Magnetic Stimulation (rTMS): contralateral premotor cortex.

Group Type: SHAM_COMPARATOR

Sham Repetitive TMS over contralateral premotor cortex.

Intervention Type: DEVICE

Sham rTMS will be applied over contralateral premotor cortex. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.

Single TMS over extensor carpi ulnaris spot of motor cortex

Location of single-pulse Transcranial Magnetic Stimulation (sTMS): extensor carpi ulnaris (ECU) hotspot of primary motor cortex (M1).

Group Type: EXPERIMENTAL

Single TMS over extensor carpi ulnaris spot of motor cortex

Intervention Type: DEVICE

Single-pulse TMS will be applied over the extensor carpi ulnaris (ECU) hotspot of primary motor cortex (M1) during motor training.TMS uses magnetism to excite neurons near the surface of the brain. TMS pulses will be applied at different strengths (30%-80% maximum stimulator output) and record subsequent activity of the ECU muscle using electromyography (EMG).

Interventions

Repetitive TMS over contralateral premotor cortex.

Repetitive Transcranial magnetic stimulation (rTMS) will be applied over contralateral premotor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.

Intervention Type: DEVICE

Repetitive TMS over ipsilateral premotor cortex.

Repetitive Transcranial magnetic stimulation (rTMS) will be applied over ipsilateral premotor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.

Intervention Type: DEVICE

Repetitive TMS over contralateral primary motor cortex.

Repetitive Transcranial magnetic stimulation (rTMS) will be applied over contralateral primary motor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain.Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.

Intervention Type: DEVICE

Sham Repetitive TMS over contralateral premotor cortex.

Sham rTMS will be applied over contralateral premotor cortex. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.

Intervention Type: DEVICE

Single TMS over extensor carpi ulnaris spot of motor cortex

Single-pulse TMS will be applied over the extensor carpi ulnaris (ECU) hotspot of primary motor cortex (M1) during motor training.TMS uses magnetism to excite neurons near the surface of the brain. TMS pulses will be applied at different strengths (30%-80% maximum stimulator output) and record subsequent activity of the ECU muscle using electromyography (EMG).

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Have the ability to give informed, written consent
• Be aged 30-80 years old
• Have a single ischemic infarction affecting the primary motor system
• Have intact cognitive abilities
• No current depression
• No neurological disease
• No contradictions to TMS

• No history of seizures or epilepsy
• No implanted medical device
• No metal in neck or head
• No history of migraine headaches
• No intake of medication that lowers seizure threshold

Exclusion Criteria

• none

• Minimum Eligible Age: 30 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Emory University

OTHER

Sponsor Role: lead

Responsible Party

Cathrin Buetefisch

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Cathrin Buetefisch, MD

Role: PRINCIPAL_INVESTIGATOR

Emory University

Other Identifiers

IRB00097855

Identifier Type: -

Identifier Source: org_study_id