rTMS Treatment of Spasticity in Children With Cerebral Palsy/ Hemiplegia Due to ABI - a RCT

NCT ID: NCT06128746

Last Updated: 2024-03-13

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

RECRUITING

Clinical Phase

NA

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-13

Study Completion Date

2025-07-31

Brief Summary

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This RCT aims to investigate the effect of repetitive transcranial magnatic stimulation (rTMS) in treating children with hemiplegoc cerebral palsy. The study will measure any improvement in spasticity after using contra-lesional inhibitory rTMS follow by intensive limb training.

Participants will attend a 10-day rTMS treatment sessions, follow by intensive training of the impaired limb. They will also undergo MRI scans before and after the treatment to investiagte the underlying neurophysiological mechanisms that lead to changes clinically by using TMS as well as MR-DKI. Researchers will compare the intervention group and the sham group to see if rTMS could result in improvement of participants' spasticity.

Detailed Description

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Cerebral palsy is the most common cause of lifelong physical disability in childhood, with an estimated prevalence of 1.5 per 1000 living biths for primary school-aged children. Spasticity is the most common symptoms in children with cerebral palsy, leading to muscle weakness affecting gross motor functions and causing complications such as pain, contracture and subluzation which will lead to inability to perform activity-based training and subsequently lead to further muscle weakness. Standard therapy with regular physiotherapy and occupational therapy are essential but time-consuming and the effects might not last for longer duration. Patients or caregivers decline medications because of side effects drowsiness while other interventions such as intra-thecal baclofen pump, rhizotomy or surgery are invasive.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has the ability to modulate excitation of the motor cortex area of the brain. There were past studies suggesting that using contralesional inhibitory rTMS was safe and feasible for patients with paediatric subcortical stroke and seemed to improve hand function in patients with hemiparesis. However, limited studies have been published on the effects of rTMS on improving spasticity in children with cerebral palsy. Hence, the objective of this study is to use low-frequency rTMS to the contra-lesional hemisphere in children with hemiplegic cerebral palsy to investigate if rTMS follow by intensive limb training would improve spasiticity of these children and whether the improvement can be sustained for a longer time. The underlying mechanisms that lead to the changes clinically will also be investigated by TMS and MRI.

Conditions

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CP (Cerebral Palsy)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Interventional rTMS group

The intervention group will receive 1 Hz active rTMS during treatment, lasting for 20 minutes, follow up by 30 minutes of intensive limb training.

Group Type EXPERIMENTAL

Repetitive Transcranial Magnetic Stimulation

Intervention Type DEVICE

1 Hz rTMS treatment for 20 mins, follow by 30 mins intensive limb training

Sham rTMS group

The sham group will not receive any Hz of rTMS during treatment, also lasting for 20 minutes with 30 minutes of intensive limb training afterwards.

Group Type SHAM_COMPARATOR

Sham Repetitive Transcranial Magnetic Stimulation

Intervention Type DEVICE

Sham Hz rTMS treatment for 20 mins, follow by 30 mins intensive limb training

Interventions

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Repetitive Transcranial Magnetic Stimulation

1 Hz rTMS treatment for 20 mins, follow by 30 mins intensive limb training

Intervention Type DEVICE

Sham Repetitive Transcranial Magnetic Stimulation

Sham Hz rTMS treatment for 20 mins, follow by 30 mins intensive limb training

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patients aged between 7 years and 18 years
* Diagnosis of cerebral palsy with hemiplegia
* Upper limb spasticity ≥ 1
* IQ ≥ 50

Exclusion Criteria

* Any contra-indications to rTMS
* Severe spasticity (score of 4 or more in Ashworth scale)
* Uncontrollable epilepsy
* History of Botulinum toxin A injection in previous 6 months
* Upper limb casting in previous 6 months
Minimum Eligible Age

7 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

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Winnie Wan Yee Tso (Dr)

Clinical Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Li Ka Shing Faculty of Medicine

Hong Kong, , Hong Kong

Site Status RECRUITING

Countries

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Hong Kong

Central Contacts

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Winnie Wan Yee Tso, MBBS

Role: CONTACT

+85222554295

Oscar Lok Kan Leung, MSocSc

Role: CONTACT

+85222554375

Facility Contacts

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Oscar Leung, MSocSc

Role: primary

+85222554375

Other Identifiers

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rTMSCPHKU

Identifier Type: -

Identifier Source: org_study_id

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