Cerebellar rTMS Theta Burst for Postural Instability in Progressive Supranuclear Palsy

NCT ID: NCT04222218

Last Updated: 2020-01-22

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

NA

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-06-01

Study Completion Date

2019-11-15

Brief Summary

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Objective of the study:

To test the efficacy of theta burst cerebellar stimulation on postural instability in progressive supranuclear palsy using a cross-over design and wearing sensors technology

Design:

Twenty probable PSP patients with no dementia and still able to walk will be recruited for a cross-over sham-controlled study. Each patient will undergo a sham stimulation or a single session of cerebellar theta burst stimulation with a wash out period of at least 14 days.

Each patient will be evaluated before and after stimulation by berg balance tests (BBS), Tinetti scale, PSP-rating scale (PSP-RS), and a battery of gait and movement tests.

Static balance was assessed by 30-seconds-trials in semitandem and tandem positions with eyes open and closed using wearing sensors technology.

Detailed Description

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Background:

There are no medical effective treatments for progressive supranuclear palsy (PSP). Imaging, neurophysiology and pathology studies suggested cerebellum as possible target of brain stimulation for postural instability using theta Burst repetitive Transcranial magnetic stimulation

Objective of the study:

To test the efficacy of theta burst cerebellar stimulation on postural instability in progressive supranuclear palsy using a cross-over design and wearing sensors technology

Design:

Probable PSP patients able to walk and without dementia/behavioral disturbances will be recruited for a cross-over sham-controlled study. Each patient will undergo a sham stimulation or a single session of cerebellar theta burst stimulation with a wash out period of at least 14 days.

Repetitive cerebellar theta burst stimulation will be performed by Duo-Mag XT100, using a 3 pulses at 50-Hz repeated at a rate of 5-Hz; 20 trains of 10 bursts given with 8-s intervals for a total of 600 pulses. Intensity of rTMS was set at the 80% of Amplitude of Motor Threshold (RMT) obtained in the left motor cortex for each subject.

A sample size of 20 subjects with complete stimulation (2 stimulations per subject, for a total number of stimulation)

Each patient will be evaluated before and after stimulation by berg balance tests (BBS), Tinetti scale, PSP-rating scale (PSP-RS), and a battery of gait and movement tests.

Static balance was assessed by 30-seconds-trials in semitandem and tandem positions with eyes open and closed using wearing sensors technology.

Sensors assessment:

The following parameters will be evaluated before and after stimulation (real vs sham): The parameter i) TIME, defined as time without falling ii) The parameter "surface", defined as the sway area iii) Velocity describes the mean velocity of the compensatory movements given in mm/s. iv) Acceleration described as root mean square (RMS), v) Jerk, the time derivate of acceleration, quantifies smoothness of the compensatory movements given in mG/s.

Conditions

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Progressive Supranuclear Palsy Fall Gait, Rigid Parkinsonism

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Each patient received both rTMS and sham cerebellar stimulation in randomized order in two different sessions, separated by at least 2 weeks. In each session, motor tasks, clinical scales and wearing sensor assessments were tested twice in all patients: at baseline (pre-stimulation) and after rTMS (post-stimulation)
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators
The patient and the examiner who administered the clinical scales were blind to the type of rTMS delivered, which was applied by another blinded experimenter.

Study Groups

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Real Stimulation

Cerebellar Repetitive theta burst stimulation will be performed using a 3 pulses at 50-Hz repeated at a rate of 5-Hz; 20 trains of 10 bursts given with 8-s intervals for a total of 600 pulses. Intensity of rTMS was set at the 80% of Amplitude of Motor Threshold (RMT) obtained in the left motor cortex for each subject.

Group Type ACTIVE_COMPARATOR

repetitive transcranial magnetic stimulation

Intervention Type DEVICE

Cerebellar repetitive theta Burst stimulation will be performed as detailed in the Real arm description

Sham Stimulation

The rTMS coil stimulation will be applied in the same position of the real stimulation. The Stimulation will be performed like in the real arm with the difference that the coil will be masked and thus will be inactive. The patient will hear the same sound of real stimulation, which will be only functionally inactive but will be completely performed (for the whole time of duration of stimulation)

Group Type SHAM_COMPARATOR

repetitive transcranial magnetic stimulation

Intervention Type DEVICE

Cerebellar repetitive theta Burst stimulation will be performed as detailed in the Real arm description

Interventions

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repetitive transcranial magnetic stimulation

Cerebellar repetitive theta Burst stimulation will be performed as detailed in the Real arm description

Intervention Type DEVICE

Other Intervention Names

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rTMS theta Burst, rTMS

Eligibility Criteria

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Inclusion Criteria

* probable PSP diagnosis
* ability to stand alone without support for at least 5 seconds
* ability to walk without aid for at least three meters

Exclusion Criteria

* dementia or behavioral alterations
* contraindications of stimulation
Minimum Eligible Age

40 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Brescia, Neurology Department

UNKNOWN

Sponsor Role collaborator

University of Kiel, Neurogeriatric Department

UNKNOWN

Sponsor Role collaborator

Fondazione Europea di Ricerca Biomedica Ferb Onlus

OTHER

Sponsor Role lead

Responsible Party

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Andrea Pilotto

parkinson's disease Rehabilitation Centre

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Andrea Pilotto, MD

Role: PRINCIPAL_INVESTIGATOR

Università degli Studi di Brescia

Locations

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Parkinson's disease Rehabilitation Centre - FERB ONLUS

Trescore Balneario, , Italy

Site Status

Countries

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Italy

Other Identifiers

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191201

Identifier Type: -

Identifier Source: org_study_id

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