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CompletedNCT03456362Updated Mar 7, 2018

Cerebellar rTMS to Improve Gait Recovery

An interventional study of REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION in Stroke and Gait, Hemiplegic, sponsored by I.R.C.C.S. Fondazione Santa Lucia. Completed at 1 site in Italy. Open to participants aged 30 Years to 80 Years. Per ClinicalTrials.gov, last updated 2018-03-07.

Sponsored by I.R.C.C.S. Fondazione Santa Lucia · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
40
Allocation
Randomized
Ages
30 Years to 80 Years
Sex
All
01

Study summary

The cerebellum is known to be strongly implicated in the functional reorganization of motor networks in stroke patients, especially for gait an balance functions. Repetitive transcranial magnetic stimulation of the cerebellum can be used to enhance these adaptive processes in stroke recovery. In this randomized, double blind, sham-controlled trial we aim to investigate the efficacy and safety of cerebellar intermittent theta burst stimulation coupled with intensive physical therapy in promoting gait recovery in hemiparetic patients due to recent stroke in the territory of the contralateral middle cerebral artery

02

Conditions studied

  • Stroke
  • Gait, Hemiplegic
03

Who can participate

Ages eligible
30 Years to 80 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • First ever-chronic ischemic stroke, i.e. at least 6 months after the stroke event,
  • Left or right subcortical or cortical lesion of the middle cerebral artery with medium-severity stroke NHISS \<15 (All lesions must be documented by magnetic resonance imaging (T1- and T2-weighted images; 1.5T, GE scanners)
  • No contraindication to brain MRI
  • MEP recordable in order to evaluate the resting motor threshold (RMT)

Exclusion criteria

Exclusion Criteria:

  • Epilepsy
  • Severe general impairment or concomitant diseases (tumors, etc.)
  • Age> 80 years
  • Infections in progress
  • Patients with neurological diseases beyond stroke or with neuropsychiatric disorders or with neuropsychological disorders that could potentially compromise informed consent or compliance during the study.
  • Treatment with benzodiazepines, baclofen, antidepressants, clonidine, beta blockers and other potentially interfering drug treatments on plasticity phenomena.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Investigator)
Enrollment
40 participants (actual)

Study arms

  • Active comparator
    Cerebellar iTBS

    Intermittent theta burst stimulation applied immediately before the daily physical therapy session for a period of three weeks.

    Device: REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION

  • Sham comparator
    Sham iTBS

    Sham intermittent theta burst stimulation applied immediately before the daily physical therapy session for a period of three weeks.

    Device: REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION

Interventions

  • DeviceREPETITIVE TRANSCRANIAL MAGNETIC STIMULATION

    theta burst stimulation (TBS) is a novel form of repetitive transcranial magnetic stimulation that mimics protocols inducing long-term potentiation (LTP) or long-term depression (LTD) in animal models. Whereas continuous TBS (cTBS) induces long-lasting inhibition of cortical areas, iTBS exerts the opposite effect, increasing cerebellar excitability

05

What researchers measure

Primary outcomes

  1. Berg Balance Scale (BBS) for gait and balance

    Assessment of gait and balance functions

    Time frame: Change from baseline at the end of three weeks treatment

Secondary outcomes

  1. Fugl-Meyer Assessment (FMA) scale

    Assessment of motor functions

    Time frame: Change from baseline at the end of three weeks treatment

  2. Barthel Index (BI)

    Assessment of functional abilities

    Time frame: Change from baseline at the end of three weeks treatment

  3. Neurophysiological assessment of cortical activity

    evaluation of cortical activity by means of TMS in combination with EEG

    Time frame: Change from baseline at the end of three weeks treatment

  4. Gait analysis

    evaluation of locomotion

    Time frame: Change from baseline at the end of three weeks treatment

06

Study locations

1 site
  • Santa Lucia Foundation
    Rome, 00179, Italy
07

References and documents

Publications

  • Koch G, Bonni S, Casula EP, Iosa M, Paolucci S, Pellicciari MC, Cinnera AM, Ponzo V, Maiella M, Picazio S, Sallustio F, Caltagirone C. Effect of Cerebellar Stimulation on Gait and Balance Recovery in Patients With Hemiparetic Stroke: A Randomized Clinical Trial. JAMA Neurol. 2019 Feb 1;76(2):170-178. doi: 10.1001/jamaneurol.2018.3639. PubMed 30476999 ↗

Individual participant data

Plan to share: Undecided

08

Registry details

Key details

Study ID
NCT03456362
Lead sponsor
I.R.C.C.S. Fondazione Santa Lucia
Responsible party
Giacomo Koch (Head of Laboratory, I.R.C.C.S. Fondazione Santa Lucia) — Principal investigator
First posted
Mar 7, 2018
Start date
Mar 1, 2014
Primary completion
Jun 1, 2017
Completion
Oct 1, 2017
Last update
Mar 7, 2018

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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