ClinicalTrials.gg
RecruitingNCT06569550FANTiMSUpdated Sep 22, 2026

Fatigue Alleviation Through Neuromodulating Therapy in Multiple Sclerosis

An interventional study of Real Repetitive Transcranial Magnetic Stimulation and Sham Repetitive Transcranial Magnetic Stimulation in Multiple Sclerosis, Relapsing-Remitting and Fatigue, sponsored by Danish Research Centre for Magnetic Resonance. Recruiting at 1 site in Denmark. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-09-22.

Sponsored by Danish Research Centre for Magnetic Resonance · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Started Aug 2024; still recruiting 2 years 2 months later.
Phase
Not applicable
Study type
Interventional
Enrollment
60
Allocation
Randomized
Ages
18 Years to 65 Years
Sex
All
01

Study summary

The goal of this clinical trial is to learn if repetitive Transcranial Magnetic Stimulation (rTMS) of the left premotor cortex can lessen fatigue in patients with Multiple Sclerosis, and if this is a feasible intervention. It will also give further information on fatigue in Multiple Sclerosis. The main questions it aims to answer is:

  • Does premotor rTMS decrease fatigue symptoms in patients with Multiple Sclerosis?
  • Is the change in fatigue reflected in an altered balance between brain excitation and inhibition in the targeted premotor cortex?

Researchers will compare real rTMS with sham rTMS (which does not stimulate with a magnetic field), to see if real rTMS works to alleviate fatigue.

Participants will:

  • Receive real or sham rTMS for 30 minutes, 5 days in a row
  • Visit the clinic before and 6 days after for baseline and follow-up
  • Fill out on-line questionnaires 1 day and 4 weeks after the end of intervention
  • Undergo a total of 3 brain scans (Magnetic Resonance Imaging at ultra-high field), at baseline, end of intervention, and follow-up
  • Undergo lab neurophysiological measurements before and after the first intervention session
  • Keep a fatigue diary and wear an activity tracker in the period before and after the intervention
Read the detailed description

BACKGROUND:

Multiple sclerosis (MS) is an immune mediated disease, targeting the central nervous system. Globally, the prevalence and incidence are increasing. It is a chronic condition, with no known definitive cure. Fatigue is among the most disabling MS symptoms, and is highly prevalent afflicting up to 78%-95% of patients. Fatigue in persons with MS (PwMS) is consistently associated with lower quality of life and severity of fatigue is generally associated with employment status, and may worsen over time.

PATHOPHYSIOLOGY:

The pathophysiological basis for fatigue in MS is poorly understood, with several possible contributors. However, trait fatigue in everyday life associates with task-related hyperactivation of the premotor cortex during a non-fatiguing grip force task. Patients who are able to increase premotor activity after performing a fatiguing motor task are less affected by fatigue during everyday life. Taken together, these findings support the hypothesis, that patients suffering from trait fatigue allocate their premotor "neural resources" less efficiently than patients without fatigue. This implies a mismatch in the physiological neuronal inhibition/excitation balance, and is evident as hyperactivity of the premotor cortex during "normal" motor activities, which in turn impedes an efficient upscaling of premotor activity.

CURRENT TREATMENTS:

Currently, the pharmacological treatment options for MS-related fatigue are limited and unsatisfactory. Neither of the 2 commonly used pharmaceutical agents, Amantadine nor Modafinil, show both a significant and a clinically relevant reduction in fatigue. Physical exercise has an overall positive, and clinically relevant, effect on MS-related fatigue, but physical therapy is not a feasible intervention for all PwMS. Evidence from TMS studies of the motor-cortex in fatigued PwMS, suggests that this effect may be mediated by changes in motor network excitability.

RTMS:

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive method for inducing plastic focal changes in the brain. It has been investigated for multitudes of ailments, and is considered a generally safe intervention. rTMS has been repeatedly shown to have a direct and lasting neuromodulating effect on the motor cortex after stimulation of the premotor network. It is suggested that inhibitory rTMS targeting the dorsal premotor cortex can improve motor performance.

PREVIOUS TRIALS:

While rTMS is extensively investigated in other contexts, there exists few studies on MS-related fatigue. A single small study (n=33), focused on safety, targeting either motor cortex or prefrontal cortex with an H-coil, failed to show a significant effect of the intervention. Several studies have shown an effect on fatigue as a secondary outcome. However, the heterogeneity in interventional protocol and target prevents further analysis. As far as the investigators are aware, no studies have investigated alleviating fatigue by neuromodulation of the premotor network.

OBJECTIVES:

The investigators will conduct a double-blinded randomized controlled trial, investigating the effect of rTMS in fatigue in PwMS. The investigators will conduct clinical measurements for their primary outcome. Clinical outcomes will be supported by ultra-high field MRI and neurophysiological measurements, as well as supplementary clinical outcomes, in order to acquire a broad dataset for further illumination of mechanisms. For outcomes, see relevant section.

STUDY DESIGN:

The trial consists of a baseline period; an intervention period; and a follow-up period.

At the baseline visit (D0), all participants will undergo clinical testing; structural 7T MRI; 7T MR Spectroscopy (MRS) to acquire baseline neurometabolite concentrations; functional connectivity (rs-fMRI) and structural connectivity (DWI). Between D0 and the first intervention day, participants will wear a wrist-borne accelerometer and fill out a fatigue diary.

The intervention period consists of 5 sequential weekdays, Monday through Friday. On the first day of treatment (D1), neurophysiological measures of motor excitation/inhibition will be acquired before and immediately after the intervention, using single- and paired-pulse TMS, with electromyography (EMG) as a readout. On the fifth and last intervention day (D5), participants will undergo immediate follow-up 7T MRI with metabolic, functional- and structural connectivity measures.

The main follow-up is 6 days after the last rTMS session, day 11 counting from first intervention. Here they will undergo follow-up clinical testing, follow-up 7T MRI with metabolic, functional- and structural connectivity measures. Between D5 and the Follow-up, participants will again wear a wrist-borne accelerometer and fill out a fatigue diary. At first day after end of intervention, and at 4 weeks after end of intervention, participants will be invited to fill out electronic questionnaires of relevant patient-reported outcomes.

CRITERIA FOR DISCONTINUATION:

Patients are discontinued in the study in case of inability to perform a baseline MRI scan; occurrence of MS relapse; new occurrence of any condition that is a contraindication for rTMS; excessive lack of compliance to the experimental protocol as assessed by the experimenters. Additionally, all subjects reserve the right to, at any time, withdraw from the study for any reason.

QUALITY ASSURANCE:

This is a one-site study, and will be monitored by an internal monitoring process, akin to Good Clinical Practice guidelines. All procedures will be done according to a pre-defined protocol, ensuring a standard operating procedure for acquisition of all data.

Additionally. The MR- and EMG-data quality is inspected during and right after data acquisition, as is normal practice in the clinical routine and research.

Logbooks are kept for all sessions and all deviations from protocol will be noted. Data quality is further assessed through the subsequent offline data processing stage, through standardized processing pipelines.

All staff who perform MR and TMS have received comprehensive training in the respective methods, as well as safety training. All staff involved in the project will be familiar with the procedure and methods and trained the experimental procedure before conducting measurements.

DATA ANALYSIS PLAN:

Primary outcome: All patients who attend at least one rTMS session and have follow-up data available, will be included in the intention-to-treat analysis for the primary outcome, regardless of amount of rTMS sessions completed.

EMG and MRI data will be preprocessed by a blinded researcher according to standardized pipelines. For EMG data, all trials will be manually checked by a blinded researcher for muscle artefacts preceding the TMS pulse, and offending trials removed.

02

Conditions studied

  • Multiple Sclerosis, Relapsing-Remitting
  • Fatigue

Keywords

  • Transcranial Magnetic Stimulation, Repetitive
  • Magnetic Resonance Imaging
  • Magnetic Resonance Imaging, Spectroscopy
03

In context

Multiple Sclerosis, Relapsing-Remitting

618 studies on the registry are indexed under Multiple Sclerosis, Relapsing-Remitting; 82 are open to participants now.

This study's planned enrollment of 60 is close to the median of 66 across 437 interventional studies indexed under Multiple Sclerosis, Relapsing-Remitting.

Browse Multiple Sclerosis, Relapsing-Remitting studies →

Lead sponsor

Danish Research Centre for Magnetic Resonance is the lead sponsor of 14 studies on the registry; 9 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • A confirmed diagnosis of relapse-remitting or secondary progressive multiple sclerosis, according to most recent McDonald's criteria (Thompson et al., 2018). This diagnosis must not be more recent than 3 months
  • Must have fatigue as a complaint, and an FSMC score corresponding to at least moderate fatigue (>53)
  • Stable MS medication for at least 3 months

Exclusion criteria

Exclusion Criteria:

  • Pregnancy, any subject with the potential to become pregnant must ensure against this (e.g. by taking oral , or other high efficacy method)
  • MS Relapse or treatment within 3 months prior to inclusion
  • Current treatment targeted towards fatigue, or previous if discontinued within 3 months prior to inclusion
  • History of neurologic disease or other significant medical conditions, aside from MS
  • EDSS > 6.5
  • Major psychiatric disorder, including current clinical depression.
  • Intake of medication that primarily acts on CNS or neurotransmission, except SSRI or SNRI
  • Pacemaker or other implanted electronic devices
  • Any intracranial metal
  • Any metallic implant incompatible with MR scanning
  • Claustrophobia
  • Either patient or their close relatives suffering from epilepsy
  • Current Drug or alcohol abuse
Terms in these criteria, in plain language(2)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
60 participants (estimated)

Study arms

  • Active comparator
    Active Repetitive Transcranial Magnetic Stimulation (rTMS)

    Active Repetitive Transcranial Magnetic Stimulation (rTMS)

    Device: Real Repetitive Transcranial Magnetic Stimulation

  • Sham comparator
    Sham Repetitive Transcranial Magnetic Stimulation

    Sham Repetitive Transcranial Magnetic Stimulation

    Device: Sham Repetitive Transcranial Magnetic Stimulation

Interventions

  • DeviceReal Repetitive Transcranial Magnetic Stimulation

    Five sessions of real paired-pulse rTMS at 0.72Hz (inter-pulse interval of 30ms and inter-pair interval of 1381ms), for a total of 1300 pulse-pairs (30 minutes), across 5 sequential days, Monday to Friday. The stimulation is applied with a MagPro XP Orange stimulator (MagVenture A/S, Farum, Denmark), through a B65-Cool-A/P-CO coil (Magventure A/S) with an active and placebo (sham) side. The active side is an actively cooled figure-of-eight coil with an outer diameter of 65mm. Intensity is 80% of resting motor threshold. It is kept the same across all 5 sessions. The target is the left PMd, at MNI coordinates (34, -2, 66), transformed into patient space. Optimal coil placement, with respects to induced e-field at the target coordinates, is simulated with SimNIBS, based on the participants own MR images. The coil positioning is guided and monitored continuously with a neuronavigation system (Localite, Bonn, Germany) and the aid of robotic arm (Axilum Robotics, Schiltigheim, France ).

  • DeviceSham Repetitive Transcranial Magnetic Stimulation

    Five sessions of real paired-pulse rTMS at 0.72Hz (inter-pulse interval of 30ms and inter-pair interval of 1381ms), for a total of 1300 pulse-pairs (30 minutes), across 5 sequential days, Monday to Friday. The stimulation is applied with a MagPro XP Orange stimulator (MagVenture A/S, Farum, Denmark), through a B65-Cool-A/P-CO coil (Magventure A/S) with an active and placebo (sham) side. The sham side does not deliver a magnetic pulse to the participant. The target is the left PMd, at MNI coordinates (34, -2, 66), transformed into patient space. Optimal coil placement, with respects to induced e-field at the target coordinates, is simulated with SimNIBS, based on the participants own MR images. The coil positioning is guided and monitored continuously with a neuronavigation system (Localite, Bonn, Germany) and the aid of robotic arm (Axilum Robotics, Schiltigheim, France ).

06

What researchers measure

Primary outcomes

  1. Change from baseline in patient reported fatigue severity, measured by the Fatigue Scale for Motor and Cognitive Symptoms (FSMC) from baseline to +6 days

    Difference in change in score in Fatigue Scale for Motor and Cognitive functions, between baseline and clinical follow-up, between real and sham group. It is a validated 20 item score, designed for fatigue in MS. It has motor and cognitive subscales. Range 20-100. Cut-off for mild, moderate and severe fatigue is 43, 53 and 63 respectively.

    Time frame: Follow-up at 6 days post intervention. Compared to baseline

Secondary outcomes

  1. Change from baseline in regional brain tissue concentration of glutamate/glutamine in the stimulated premotor cortex, measured by single-voxel Magnetic Resonance Spectroscopy

    Difference in change in concentration in metabolites, measured using Ultra High Field MR Spectroscopy, between baseline and day 5 of the intervention and clinical follow-up. Between real and sham group. Glutamate and Glutamine are some of the major excitatory neurotransmitters. It is measured as an outcome to assess the inhibitory load in the premotor/motor system. At lower fields, they are often combined (to Glx) due to difficulties in separating them. At 7T this is typically not necessary.

    Time frame: Day 5 of intervention and 6 days post end of intervention, compared to baseline

  2. Change from baseline in Brain tissue concentration of GABA in the stimulated premotor cortex, measured by single-voxel Magnetic Resonance Spectroscopy

    Difference in change in concentration in metabolites, measured using Ultra High Field MR Spectroscopy, between baseline and day 5 of the intervention and clinical follow-up. Between real and sham group. GABA is one of the major inhibitory neurotransmitters. It is measured as an outcome to assess the inhibitory load in the premotor/motor system.

    Time frame: Day 5 of intervention and 6 days post end of intervention, compared to baseline

  3. Change from baseline in patient reported fatigue severity, measured by the Fatigue Scale for Motor and Cognitive Symptoms (FSMC)

    Difference in change in score in Fatigue Scale for Motor and Cognitive functions, between baseline and questionnaire follow-up, between real and sham group. Changes in fatigue score at other time points, than main follow-up, will be treated as a secondary outcome. It is a validated 20 item score, designed for fatigue in MS. It has motor and cognitive subscales. Range 20-100. Cut-off for mild, moderate and severe fatigue is 43, 53 and 63 respectively.

    Time frame: Follow-up at 1 and 28 days post intervention. Compared to baseline.

  4. Change from baseline in objective fatiguability, measured by the Fatiguability Index (FI)

    Difference in change in fatiguability (state fatigue) measured as fatiguability index (FI). FI is calculated based on a sustained 30s maximum voluntary contraction, where FI is defined as the ratio between the actual area under the curve over the theoretical max if 100% had been sustained for the entire contraction. Range 0-1.

    Time frame: Follow-up at 6 days post intervention. Compared to baseline.

  5. Change from baseline in patient-reported fatiguability, measured by the Pittsburgh Fatiguability Score (PFS)

    Pittsburgh Fatiguability Score (PFS) is a self-reported rating scale of fatiguability. It contains 10 activities, each scored from 0-5 (5 being worst) for both induced cognitive and physical fatigue. The investigators have no specific hypothesis for the score at 1 day post intervention due to the retrospective aspect of this score.

    Time frame: Follow-up at 1, 6 and 28 days post intervention. Compared to baseline.

Other outcomes

  1. Change from baseline in patient reported physical fatigue severity, measured by the Fatigue Scale for Motor and Cognitive Symptoms (FSMC), physical subscore

    Difference in change in score in Fatigue Scale for Motor and Cognitive functions, for the 2 physical and cognitive subscores, between baseline and questionnaire follow-up, between real and sham group. Changes in fatigue score subscores will be treated as secondary outcomes. It is a validated 20 item score, designed for fatigue in MS. It has 10 items each for motor and cognitive subscales. Range 10-50.

    Time frame: Follow-up at 1, 6 and 28 days post intervention. Compared to baseline.

  2. Change from baseline in patient reported cognitive fatigue severity, measured by the Fatigue Scale for Motor and Cognitive Symptoms (FSMC), cognitive subscore

    Difference in change in score in Fatigue Scale for Motor and Cognitive functions, for the 2 physical and cognitive subscores, between baseline and questionnaire follow-up, between real and sham group. Changes in fatigue score subscores will be treated as secondary outcomes. It is a validated 20 item score, designed for fatigue in MS. It has 10 items each for motor and cognitive subscales. Range 10-50.

    Time frame: Follow-up at 1, 6 and 28 days post intervention. Compared to baseline.

  3. Per-session changes in patient reported fatigue using the Visual-Analogue Fatigue Scale (VAFS)

    Difference in change in fatigue, by VAFS scale, before/after each intervention, across the 5 intervention sessions. Participants will self-assess fatigue by a VAS scale before and after each intervention. Asking before and after at each sessions allows differentiation between acute effects due to the intervention, and effects that consolidate between sessions.

    Time frame: Time-series, 5 intervention days.

  4. Change from baseline in patient-reported depression symptoms, measured with the Major Depression Inventory (MDI)

    MDI depression score is a commonly used rating scale for depressive symptoms. Range 0-50. Cut-offs for mild-, moderate- and severe depression are 21, 26 and 31 respectively.

    Time frame: Follow-up at 6 days post intervention. Compared to baseline.

  5. Change from baseline in motor-network functional connectivity, measured by resting state functional MRI

    Resting state (rs-) Blood-oxygen level dependent (BOLD-) functional (f-) Magnetic Resonance Imaging (MRI) is a method for quantifying functional connectivity. The investigators will analyze the functional connectivity within the premotor-motor network, and how this connectivity changes as a result of the intervention. An exploratory framework to illuminate mechanisms of fatigue will be employed.

    Time frame: Day 5 of intervention and 6 days post end of intervention, compared to baseline

  6. Change from baseline in motor network structural connectivity, measured by Diffusion Weighted Imaging

    Diffusion Weighted Imaging (DWI) is a special MR technique to describe brain microstructure, most commonly white matter fiber direction and integrity. The investigators will analyze the structural connectivity within the premotor-motor network, and how this connectivity changes as a result of the intervention. An exploratory framework to illuminate mechanisms of fatigue will be employed.

    Time frame: Day 5 of intervention and 6 days post end of intervention, compared to baseline.

  7. Change from baseline in patient reported sleep quality, measured by the Epworth Sleepiness Scale (ESS)

    Difference in change in Epworth Sleepiness Scale. The ESS is a well-validated and often used score of sleepiness, used across many different fields. The range is from 0-24 and a score above 10 usually indicated a dysfunction of sleep.

    Time frame: Follow-up at 1, 6 and 28 days post intervention. Compared to baseline.

  8. Change from baseline in patient-reported symptom severity, measured by the Multiple Sclerosis Impact Scale (MSIS-29)

    Multiple Sclerosis Impact Scale (MSIS-29) is a self-reported rating scale for the impact of MS on daily quality of life. It contains 29 items, scored from 1-5 (5 being worst).

    Time frame: Follow-up at 1, 6 and 28 days post intervention. Compared to baseline.

  9. Per-session patient reported side-effects, with the TMS Adverse Events and Associated Sensations Questionnaire (TMS-SENS-Q)

    The TMS Adverse Events And Associated Sensations Questionnaire (TMS-SENS-Q) will be used to ask participants to self-report side-effects of rTMS after each rTMS intervention. It asks participants to self-report severity, onset and duration of 20 potential symptoms of TMS, including "other".

    Time frame: Time-series, 5 intervention days.

  10. Change from baseline in bimanual dexterity, measured with the 9-hole peg test (9HPT)

    Cohort description, exploratory. Difference in change in scores in 9-hole peg test. The 9HPT is well-validated and often used test of fine motor function. The score consists of the average completion time across 2 trials per hand. There exists normative material, stratified by age.

    Time frame: Follow-up at 6 days post intervention. Compared to baseline.

  11. Change from baseline in processing speed, measured with the Symbol Digit Modalities Test (SDMT)

    Cohort description, exploratory. Difference in change in scores in Symbol Digit Modalities Test. The SDMT is a well-validated and often used cognitive test, generally considered to assess processing speed. The score is the total number of symbols correctly assigned a number via a pre-determined key, in 90 seconds. There exists normative material, stratified by age.

    Time frame: Follow-up at 6 days post intervention. Compared to baseline.

  12. Change from baseline in ambulation speed, measured with the Timed 25ft walk test (T25FW)

    Cohort description, exploratory. Difference in change in scores in 25ft walk test. The T25FW is a well-validated and often used test to assess walking ability. The score is the average time taken to walk 25ft across 2 trials. There exists normative material, stratified by age.

    Time frame: Follow-up at 6 days post intervention. Compared to baseline.

  13. Change from baseline in visual memory, measured with the Brief Visual Memory Test, revised edition (BVMT-R)

    Cohort description, exploratory. Difference in change in scores in BVMT-R. The BVMT-R is a well-validated and often used test to assess short term visual memory, in MS. The score is the sum of remembered visual cues across 3 trials, in accordance with BICAMS guidelines. There exists normative material, stratified by age.

    Time frame: Follow-up at 6 days post intervention. Compared to baseline.

  14. Change from baseline in verbal memory, measured with the California Verbal Learning Test (CVLT)

    Cohort description, exploratory. Difference in change in scores in CVLT. The CVLT is a well-validated and often used test to assess short term verbal memory, in MS. The outcome is the sum og words recalled across the 5 initial trials, in accordance with BICAMS guidelines. There exists normative material, stratified by age.

    Time frame: Follow-up at 6 days post intervention. Compared to baseline.

  15. Multiple Sclerosis related disability, measured by the Extended Disability Status Scale (EDSS) at baseline

    Used for proper cohort description when reporting. The EDSS is a clinical rating scale ranging from 0 (no symptoms or objective signs of disability related to Multiple Sclerosis) to 10 (death caused by Multiple Sclerosis).

    Time frame: One-time measurement at baseline.

  16. Change across 1 intervention session in measured Intracortical Inhibition (SICI)

    Difference in change between real and sham group, in intracortical inhibition (SICI) measured with paired-pulse TMS-EMG. The SICI is the ratio between the amplitude of a motor-evoked potential from 2 TMS pulses delivered at 80% and 120% of the resting motor threshold at an interval of 2.5ms, and a control potential evoked by a single pulse at 120% of resting motor threshold.

    Time frame: Day 1, measurements done immediately (within 1 hour) before and after the intervention

  17. Change across 1 intervention session in measured Intracortical Facilitation (ICF)

    Difference in change between real and sham group, in intracortical facilitation (ICF) measured with paired-pulse TMS-EMG. The ICF is the ratio between the amplitude of a motor-evoked potential from 2 TMS pulses delivered at 80% and 120% of the resting motor threshold at an interval of 10ms, and a control potential evoked by a single pulse at 120% of resting motor threshold.

    Time frame: Day 1, measurements done immediately (within 1 hour) before and after the intervention

  18. Change across 1 intervention session in TMS-evoked recruitment curve at rest

    Difference in change between real and sham group, in characteristics of at-rest recruitment curve, measured with single-pulse TMS-EMG. A recruitment curve is the characteristic input/output relationship between stimulation-intensity of the TMS-pulse and the amplitude of the motor-evoked potential.

    Time frame: Day 1, measurements done immediately (within 1 hour) before and after the intervention

  19. Change across 1 intervention session in TMS-evoked recruitment curve at slight tonic contraction

    Difference in change between real and sham group, in characteristics of recruitment curve at slight tonic contraction, measured with single-pulse TMS-EMG. A recruitment curve is the characteristic input/output relationship between stimulation-intensity of the TMS-pulse and the amplitude of the motor-evoked potential.

    Time frame: Day 1, measurements done immediately (within 1 hour) before and after the intervention

  20. Change across 1 intervention session in TMS-induced cortical silent period

    Difference in change between real and sham group, in the duration of the TMS-induced cortical silent period of the EMG-trace, measured in the hand contralateral to the stimulation site.

    Time frame: Day 1, measurements done immediately (within 1 hour) before and after the intervention

  21. Change across 1 intervention session in TMS-induced ipsilateral silent period

    Difference in change between real and sham group, in the duration of the TMS-induced ipsilateral silent period of the EMG-trace. Ipsilateral meaning the reduction in EMG-activity in the measured muscle on the same side of the participant as the stimulation site.

    Time frame: Day 1, measurements done immediately (within 1 hour) before and after the intervention

  22. Change from baseline in participant-reported fatigue severity, measured by a fatigue diary

    Difference in change in day-to-day fatigue measured using a diary of fatigue scores, filled out by each subject at home in the week before/after the intervention week. The diary consists of a VAS-fatigue scale, as well as a rating for distribution between physical and cognitive fatigue. It is adapted from other sources.

    Time frame: Week after intervention, compared to week before intervention

  23. Change from baseline in participant-reported sleep quality, measured by a fatigue diary

    Difference in change in sleep quality according to fatigue diary. As part of the fatigue diary, each patient will be asked each morning for the approximate hours of sleep and the quality of their sleep.

    Time frame: Week after intervention, compared to week before intervention

  24. Change from baseline in daily activity levels, measured by a wrist-borne accelerometer

    Difference in change in stepcount based on data from wearable accelerometer, worn by each subject at home in the week before/after the intervention week.

    Time frame: Week after intervention, compared to week before intervention

  25. Change from baseline in Sleep quality, measured by a wrist-borne accelerometer

    Difference in change in sleep efficiency, as assessed based on data from wearable accelerometer, worn by each subject at home in the week before/after the intervention week.

    Time frame: Week after intervention, compared to week before intervention

  26. Effective dose at target brain region, calculated through E-field simulation

    Exploratory. Simulated effective electric field dose at the targeted brain region (PMd), based on the individual pulse stimulation locations and an individual head-model based on subject-specific MR images. Simulated using SimNIBS. Exploratory analysis of whether actual stimulation intensity drives a potential positive treatment effect.

    Time frame: Intervention Days 1-5

07

Study locations

1 of 1 sites recruiting
  • Danish Research Centre for Magnetic Resonance
    Hvidovre, Capital Region 2650, Denmark
    Recruiting
08

References and documents

Publications

  • Nygaard S, Madsen MAJ, Wiggermann V, Cabras C, Christiansen L, Svatkova A, Lundell H, Hojsgaard Chow H, Romme Christensen J, Blinkenberg M, Sellebjerg F, Siebner H. Repetitive transcranial magnetic stimulation to alleviate fatigue in multiple sclerosis-study protocol for a randomized sham-controlled double-blinded clinical trial. Front Neurol. 2026 Feb 26;17:1759679. doi: 10.3389/fneur.2026.1759679. eCollection 2026. PubMed 41835064 ↗

Individual participant data

Plan to share: No — In accordance with Danish data protection legislation, it is currently not allowed to publish individual participant data. Data that underlie published results related to the primary and secondary outcome measures will, following anonymization, be made available upon reasonable request. However, data will be grouped in appropriate age categories with minimum 5 participants in each group.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Aug 2024 (actual). Primary completion is estimated for Jan 2027, 29 months after the start.

Of 79 non-industry interventional studies with no phase under Multiple Sclerosis, Relapsing-Remitting, half reached primary completion within 29 months of starting (the median), counting those still running; a quarter within 15 and three quarters within 45. This study's planned 29 months is close to that.

Counting every sponsor, half of 81 studies reached it within 29 months; a quarter within 15 and three quarters within 47.

How these figures are worked out, and which studies are left out of them.

Registered
Aug 12, 2024
First posted
Aug 26, 2024
StartActual
Aug 14, 2024
Primary completionEst.
Jan 21, 2027
CompletionEst.
Feb 21, 2027
Last update
Sep 22, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Sep 22, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT06569550
Lead sponsor
Danish Research Centre for Magnetic Resonance
Collaborators
Danish Multiple Sclerosis Center, Scleroseforeningen, Independent Research Fund Denmark
Responsible party
Sponsor
First posted
Aug 26, 2024
Start date
Aug 14, 2024
Primary completion
Jan 21, 2027 (estimated)
Completion
Feb 21, 2027 (estimated)
Last update
Sep 22, 2026

Study contacts

Hartwig R Siebner, MD, DMSc
Contact
hartwig@drcmr.dk
3862 6541 ext. 0045
Sofus AD Nygaard, MD
Contact
sofusadn@drcmr.dk
Hartwig R Siebner, MD, DMSc
principal investigator · Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre & University of Copenhagen

Oversight

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

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Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

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Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

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