Monocentric Pilot Study, for a Randomized, Crossover, Blinded Trial: Comparison of the Therapeutic Efficacy of Low Frequency Repeated Transcranial Magnetic Stimulation on Cortical Area 9 Compared to Brodmann Area 46 in the Treatment of Depressive Disorders.

NCT ID: NCT03656900

Last Updated: 2018-09-04

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

PHASE2

Total Enrollment

17 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Study Completion Date

2013-10-31

Brief Summary

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Repetitive transcranial magnetic stimulation (rTMS) is a new therapeutic tool used in psychiatry. Non-invasive, well tolerated and requiring no premedication, it is performed on an outpatient basis. The principle of this technique is to stimulate the cerebral cortex from an electromagnetic coil placed on the scalp. Unlike electroconvulsive therapy, rTMS induces an electrical current on a well-defined region of the cerebral cortex.

In psychiatry, this technique is mainly considered in the treatment of depressive disorders resistant to antidepressant medication. The brain target, obtained from brain imaging data in depressed patients, is the dorsolateral prefrontal cortex (DLPFC). The Food and Drug Administration (FDA) has recognized the interest of rTMS for treating depressive disorders (October 7, 2008).

However, some stimulation parameters still need to be optimized before rTMS can be considered a therapeutic method in its own right and used routinely. Indeed, its effectiveness over time has not yet been evaluated, and rTMS has shown a lack of reproducibility between subjects \[Foucher, 2007\]. Finally, the therapeutic results of rTMS are very modest whatever the study \[Daskalakis, 2008\]. Additional studies are therefore needed to optimize stimulation parameters.

Detailed Description

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Conditions

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Patients With Resistant Depressive Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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BA9/BA46

Group Type EXPERIMENTAL

rTMS BA9/BA46

Intervention Type DEVICE

10 sessions of low-frequency repeated transcranial magnetic stimulation over two weeks on cortical area 9, then 4 weeks wash-out, then 10 sessions of low-frequency repeated transcranial magnetic stimulation repeated low frequency over two weeks on cortical area 46.

brain MRI

Intervention Type RADIATION

T1 weighted full-head high-resolution MRI with 1 mm seam cuts and sagittal orientation.

Medical evaluation

Intervention Type OTHER

complete evaluation with 6 scales (HDRS, MADRS, Beck, CGI, COVI, UKU)

Psychological assessment

Intervention Type OTHER

Subjective Life Profile Assessment (SLPA) and Helping Alliance Assessment

BA46/BA9

Group Type EXPERIMENTAL

rTMS BA46/BA9

Intervention Type DEVICE

10 sessions of low-frequency repeated transcranial magnetic stimulation over two weeks on cortical area 46, then 4 weeks wash-out, then 10 sessions of low-frequency repeated transcranial magnetic stimulation repeated low frequency over two weeks on cortical area 9.

brain MRI

Intervention Type RADIATION

T1 weighted full-head high-resolution MRI with 1 mm seam cuts and sagittal orientation.

Medical evaluation

Intervention Type OTHER

complete evaluation with 6 scales (HDRS, MADRS, Beck, CGI, COVI, UKU)

Psychological assessment

Intervention Type OTHER

Subjective Life Profile Assessment (SLPA) and Helping Alliance Assessment

Interventions

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rTMS BA9/BA46

10 sessions of low-frequency repeated transcranial magnetic stimulation over two weeks on cortical area 9, then 4 weeks wash-out, then 10 sessions of low-frequency repeated transcranial magnetic stimulation repeated low frequency over two weeks on cortical area 46.

Intervention Type DEVICE

rTMS BA46/BA9

10 sessions of low-frequency repeated transcranial magnetic stimulation over two weeks on cortical area 46, then 4 weeks wash-out, then 10 sessions of low-frequency repeated transcranial magnetic stimulation repeated low frequency over two weeks on cortical area 9.

Intervention Type DEVICE

brain MRI

T1 weighted full-head high-resolution MRI with 1 mm seam cuts and sagittal orientation.

Intervention Type RADIATION

Medical evaluation

complete evaluation with 6 scales (HDRS, MADRS, Beck, CGI, COVI, UKU)

Intervention Type OTHER

Psychological assessment

Subjective Life Profile Assessment (SLPA) and Helping Alliance Assessment

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Patients with resistant depressive disorders (Hamilton-17-item scale \> 22, failure ≥ 2 antidepressants) with at least one of the following criteria :

* venlafaxine treatment failure (unlike the national PHRC, patients who receive/have received venlafaxine treatment for the current depressive episode are included),
* therapeutic failure in PHRC national rTMS 2007,
* refusal to participate in the PHRC national rTMS 2007.

Exclusion Criteria

* Bipolar disorders: type I or II,
* Depression with psychotic characteristics,
* Schizophrenia,
* Risky or harmful use of alcohol and/or an illicit psychoactive substance,
* Dependence on alcohol and/or an illicit psychoactive substance,
* Sick and hospitalized under duress or under legal protection (guardianship, curatorship),
* Contraindication to the practice of rTMS; personal history of seizures, history of neurological or neurosurgical pathologies, metallic prosthetic materials or foreign bodies (pacemaker, etc...),
* Contraindication to brain MRI,
* Pregnancy or breastfeeding in progress
* Resistance to Escitalopram
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Centre Hospitalier Universitaire Dijon

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Chu Dijon Bourogne

Dijon, , France

Site Status

Countries

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France

Other Identifiers

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TROJAK 2009

Identifier Type: -

Identifier Source: org_study_id

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