Cerebral Reorganization in Cervical Myelopathy Measured by Navigated Transcranial Magnetic Stimulation
NCT ID: NCT03312608
Last Updated: 2017-10-18
Study Results
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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UNKNOWN
160 participants
OBSERVATIONAL
2017-01-01
2023-02-01
Brief Summary
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Detailed Description
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To the investigators knowledge, this study is the first to analyze changes of corticospinal excitability and reorganization in patients with cervical spondylotic myelopathy with navigated TMS. In the present study, there was a significant difference in parameters of excitability and motor area activation between the severely symptomatic and clinically stable patient group. The investigators analysis showed that chronic CSM induces a recruitment of the non-primary motor area and corticospinal disinhibition, so that axonal damage can be compensated through recruitment of new cortical and supplementary motor connections, to a certain degree. Upon exhaustion of these mechanisms further axonal damage translates directly into new neurological deficits. These results lay the ground for a novel concept in CSM, the "corticospinal reserve capacity".
This study lays the foundation for future research to examine the pathomechanisms in CSM. Functional reorganization occurs on a spinal as well as on a cortical level. The concept of the corticospinal reseve capacity describes a compensatory, increased recruitment of non primary motor areas and corticospinal disinhibition in order to preserve motor function. By detecting the degree of reorganization, a stratification for an unfavourable as well as stable clinical course could be made. This innovative approach to describe the pathomechanisms in CSM might revise current concepts of clinical diagnostics and might have an impact on future treatment strategies.
Conditions
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Keywords
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Study Design
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CASE_CONTROL
PROSPECTIVE
Study Groups
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mild myelopathy (JOA>12)
40 patients (JOA\>12) suffering from symptomatic or asymptomatic degenerative cervical myelopathy scheduled for surgery or conservative treatment. The radiological inclusion criteria are cervical spinal stenosis associated with or without intramedullary high signal intensity lesion on T2-weighted MRI. Exclusion criteria are other pathologies in the vicinity of the corticospinal tract above the lesion site (i.e. tumor, infarction), neuroinflammatory disease, high grade paresis of the upper extremity (BMRC\<3), the existence of a cardiac pacemaker, deep brain stimulation electrodes or pregnancy. By means of navigated transcranial magnetic stimulation the resting motor threshold, recruitment curve, cortical silent period and motor area will be determined.
Navigated transcranial magnetic stimulation
moderate myelopathy
40 patients (JOA≤12) suffering from symptomatic degenerative cervical myelopathy scheduled for surgery (anterior and/ or posterior decompression) or conservative treatment. The radiological inclusion criteria are cervical spinal stenosis associated with or without intramedullary high signal intensity lesion on T2-weighted MRI. Exclusion criteria are other pathologies in the vicinity of the corticospinal tract above the lesion site (i.e. tumor, infarction), neuroinflammatory disease, high grade paresis of the upper extremity (BMRC\<3), the existence of a cardiac pacemaker, deep brain stimulation electrodes or pregnancy. By means of navigated transcranial magnetic stimulation the resting motor threshold, recruitment curve, cortical silent period and motor area will be determined.
Navigated transcranial magnetic stimulation
healthy control
As a control group, 40 subjects will be included into the study. Exclusion criteria and examination protocol are identical with the patient group. By means of navigated transcranial magnetic stimulation the resting motor threshold, recruitment curve, cortical silent period and motor area will be determined.
Navigated transcranial magnetic stimulation
Interventions
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Navigated transcranial magnetic stimulation
Eligibility Criteria
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Inclusion Criteria
18 Years
ALL
Yes
Sponsors
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German Spine Society (Deutsche Wirbelsäulenstiftung)
OTHER
Insel Gruppe AG, University Hospital Bern
OTHER
University Hospital of Cologne
OTHER
University Hospital Munich
OTHER
Charite University, Berlin, Germany
OTHER
Responsible Party
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Anna Zdunczyk
principal investigator, physician
Principal Investigators
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Anna Zdunczyk, M.D.
Role: PRINCIPAL_INVESTIGATOR
Charite University, Berlin, Germany
Locations
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Department of neurosurgery Charité
Berlin, , Germany
Countries
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Central Contacts
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Facility Contacts
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Anna Zdunczyk, M.D.
Role: primary
Other Identifiers
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89830535
Identifier Type: -
Identifier Source: org_study_id