Double Dose 4-AP on Functional Recovery After Spinal Cord Injury

NCT ID: NCT06853015

Last Updated: 2025-04-03

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

PHASE1/PHASE2

Total Enrollment

27 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-02-01

Study Completion Date

2026-03-31

Brief Summary

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The purpose of this study is to test a strategy to potentiate functional recovery of lower limb motor function in individuals with spinal cord injury (SCI). The FDA approved drug, Dalfampridine (4-AP). 4-AP will be used twice-daily in combination of Spike-timing-dependent plasticity (STDP) stimulation and STDP stimulation with limb training.

Detailed Description

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Currently, research has shown that 4-AP has a positive effect on sensory and motor function rehabilitation in humans with chronic SCI in addition to decreasing recorded spasticity, increased sensation, and decreased pain. A pharmacokinetic study showed that twice-daily administration of sustained release 4-AP maintains a steadier plasma concentration. Utilizing limb training to promote recovery of motor function is enhanced by eliciting STDP in the limbs. An important strength of this aim is the combination of training and STDP, which aims to enhance the beneficial effects of motor training by promoting plasticity in the corticospinal pathway. Training effects on physiological pathways will be explored and correlated with lower limb motor function. We hypothesize that introducing 4-AP into the STDP stimulation and STDP stimulation with training will further improve motor function rehabilitation in patients with chronic SCI.

Conditions

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SCI - Spinal Cord Injury

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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4-AP(AM) + STDP stimulation + training + 4-AP(PM)

The effects of the functional recovery of the lower-limb muscles will be determined after 40 sessions of twice-daily-dosing 4-AP, STDP stimulation and training.

Group Type EXPERIMENTAL

Dalfampridine

Intervention Type DRUG

The study drug (4-AP) will be administered as a 10 mg dose twice a day.

STDP stimulation

Intervention Type OTHER

Paired stimulation will be given to the spinal cord and to peripheral nerves so that the signals are received at the spinal cord at a specific interval.

Exercise training

Intervention Type BEHAVIORAL

Lower-limb exercises will involve over-ground walking, treadmill, walking and stair climbing training.

Placebo(AM) + STDP stimulation + training + Placebo(PM)

The effects of the functional recovery of the lower-limb muscles will be determined after 40 sessions of twice-daily-dosing Placebo, STDP stimulation and training.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

The placebo provided by the SRAL pharmacy that looks identical to the 4-AP, will be administered twice a day.

STDP stimulation

Intervention Type OTHER

Paired stimulation will be given to the spinal cord and to peripheral nerves so that the signals are received at the spinal cord at a specific interval.

Exercise training

Intervention Type BEHAVIORAL

Lower-limb exercises will involve over-ground walking, treadmill, walking and stair climbing training.

Interventions

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Dalfampridine

The study drug (4-AP) will be administered as a 10 mg dose twice a day.

Intervention Type DRUG

Placebo

The placebo provided by the SRAL pharmacy that looks identical to the 4-AP, will be administered twice a day.

Intervention Type DRUG

STDP stimulation

Paired stimulation will be given to the spinal cord and to peripheral nerves so that the signals are received at the spinal cord at a specific interval.

Intervention Type OTHER

Exercise training

Lower-limb exercises will involve over-ground walking, treadmill, walking and stair climbing training.

Intervention Type BEHAVIORAL

Other Intervention Names

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Hebbian stimulation spike timing dependent plasticity

Eligibility Criteria

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Inclusion Criteria

* Male and females between ages 18-85 years
* SCI 6 months post injury
* Spinal Cord injury at or above L2
* ASIA A, B, C, or D, complete or incomplete
* The ability to perform a small visible contraction with dorsiflexion and hip flexor muscles

Exclusion Criteria

* Uncontrolled medical problems including pulmonary, cardiovascular or orthopedic disease
* Any history of renal impairment
* Any debilitating disease prior to the SCI that caused exercise intolerance
* Premorbid, ongoing major depression or psychosis, altered cognitive status
* History of head injury or stroke
* Vascular, traumatic, tumoral, infectious, or metabolic lesion of the brain, even without history of seizure, and without anticonvulsant medication
* History of seizures or epilepsy
* Receiving drugs acting primarily on the central nervous system, which lower the seizure threshold (see appendix 2)
* Pregnant females
* If a women of child bearing age is unsure of the pregnancy, and does not want to take the pregnancy test
* Ongoing cord compression or a syrinx in the spinal cord or who suffer from a spinal cord disease such as spinal stenosis, spina bifida, MS, or herniated disk
* Metal plate in skull
* Individuals with scalp shrapnel, cochlear implants, or aneurysm clips
* Individuals taking Bupropion, Dolutegravir, Lacosamide, Trilaciclib, or PR Interval prolonging drugs
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Shirley Ryan AbilityLab

OTHER

Sponsor Role lead

Responsible Party

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Monica Perez

Scientific Chair

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Monica Perez, PT, PhD

Role: PRINCIPAL_INVESTIGATOR

Shirley Ryan Ability Lab

Locations

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Shirley Ryan Abilitylab

Chicago, Illinois, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Monica Perez, PT, PhD

Role: CONTACT

312-238-2886

Bing Chen, PhD

Role: CONTACT

312-238-7895

Facility Contacts

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Monica Perez, PT, PhD

Role: primary

312-238-2886

Other Identifiers

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STU00221545

Identifier Type: -

Identifier Source: org_study_id

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