Repetitive Transcranial Magnetic Stimulation (TMS) for Progressive Supranuclear Palsy and Corticobasal Degeneration

NCT01174771 | Completed

• 2 other identifiers: UCaliforniaLACurePSP
• Study Type: observational
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Drug therapy of atypical parkinsonism is generally considered either ineffective or minimal 1. Therefore, there is an urgent need to find alternative therapies to treat atypical parkinsonian disorders. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive tool that modulates cortical excitability with minimal discomfort and holds therapeutic promise in treating neurological and psychiatric disorders. The basal ganglia-thalamocortical circuits that are affected in Progressive Supranuclear Palsy (PSP) and Corticocbasal Ganglionic Degeneration (CBGD) are likely structurally and functionally segregated. The 'motor' circuit is implicated in parkinsonian akinesia and hypokinesia; a 'prefrontal' circuit is implicated in working memory and mood regulation, and linked with non-motor symptoms such as depression and apathy. In this proposal, we characterize motor and prefrontal network dysfunction in PSP and CBGD patients, and propose that high-frequency and low-frequency rTMS directed over separate motor and prefrontal cortical targets of each network may show specific and selective beneficial effects on motor vs. cognitive function in PSP and CBGD patients, respectively. Quantitative motor outcome measures include timed finger tapping tasks. Quantitative cognitive outcome measures comprise a visual analogue scale (VAS). If successful, this pilot study will provide proof of principle data to suggest potential benefits for rTMS in PSP/CBGD patients, and provide sufficient data and experience to support future PSP/CBGD studies that include the use of rTMS to investigate the pathophysiology of motor and non-motor features of PSP and CBGD patients.

Conditions

Progressive Supranuclear Palsy; Corticobasal Degeneration; Parkinsonism

Keywords

Transcranial magnetic stimulation; Cortical excitability; parkinsonism; Progressive Supranuclear Palsy; Corticobasal Degeneration; PSP; CBD; CBGD

Outcome Measures

Primary Outcomes (1)

• Cortical excitability (CE) measures expressed in motor evoked potentials (MEP)

  We assess cortical excitability (CE) with motor evoked potentials (MEP) and cortical silent periods (CSP) before and after repetitive Transcranial Magnetic Stimulation (TMS).

  1 hour

Secondary Outcomes (2)

• visual analog scale (VAS)

  2 min

• tapping speed

  5 min

Study Arms (3)

PSP patients

People that have been clinically diagnosed with atypical parkinsonism, i.e., PSP

CBD patients

People that have been clinically diagnosed with atypical parkinsonism, i.e., CBD

Age-matched healthy controls

People that have not been diagnosed with any kind of neurologic movement disorder.

Eligibility Criteria

• Age: 35 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

The purpose of this study is to learn more about how transcranial magnetic stimulation (TMS) affects motor and non-motor function in patients with Progressive Supranuclear Palsy (PSP) or Cortical Basal Ganglionic Degeneration (CBGD)-forms of parkinsonism.

You may qualify if:

• If you are an adult with PSP or CBGD:
• \. Must be in good physical health.
• If you are neurologically healthy volunteers:
• \. Must be older than 35 years

You may not qualify if:

• Must have no implanted metal. Dental fillings are acceptable.
• Must have no personal seizure or 1st degree relative with history of seizures
• Must not take any medication that lowers seizure threshold.

Sponsors & Collaborators

• University of California, Los Angeles: lead

Study Sites (1)

UCLA

Los Angeles, California, 90095, United States

Location

Related Publications (14)

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  PMID: 11018700 BACKGROUND

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  BACKGROUND

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  PMID: 18545773 BACKGROUND

• Filipovic SR, Rothwell JC, van de Warrenburg BP, Bhatia K. Repetitive transcranial magnetic stimulation for levodopa-induced dyskinesias in Parkinson's disease. Mov Disord. 2009 Jan 30;24(2):246-53. doi: 10.1002/mds.22348.

  PMID: 18951540 BACKGROUND

• Murase N, Rothwell JC, Kaji R, Urushihara R, Nakamura K, Murayama N, Igasaki T, Sakata-Igasaki M, Mima T, Ikeda A, Shibasaki H. Subthreshold low-frequency repetitive transcranial magnetic stimulation over the premotor cortex modulates writer's cramp. Brain. 2005 Jan;128(Pt 1):104-15. doi: 10.1093/brain/awh315. Epub 2004 Oct 13.

  PMID: 15483042 BACKGROUND

• Lefaucheur JP, Fenelon G, Menard-Lefaucheur I, Wendling S, Nguyen JP. Low-frequency repetitive TMS of premotor cortex can reduce painful axial spasms in generalized secondary dystonia: a pilot study of three patients. Neurophysiol Clin. 2004 Oct;34(3-4):141-5. doi: 10.1016/j.neucli.2004.07.003.

  PMID: 15501683 BACKGROUND

• Siebner HR, Mentschel C, Auer C, Conrad B. Repetitive transcranial magnetic stimulation has a beneficial effect on bradykinesia in Parkinson's disease. Neuroreport. 1999 Feb 25;10(3):589-94. doi: 10.1097/00001756-199902250-00027.

  PMID: 10208595 BACKGROUND

• Khedr EM, Farweez HM, Islam H. Therapeutic effect of repetitive transcranial magnetic stimulation on motor function in Parkinson's disease patients. Eur J Neurol. 2003 Sep;10(5):567-72. doi: 10.1046/j.1468-1331.2003.00649.x.

  PMID: 12940840 BACKGROUND

• Lefaucheur JP, Drouot X, Von Raison F, Menard-Lefaucheur I, Cesaro P, Nguyen JP. Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson's disease. Clin Neurophysiol. 2004 Nov;115(11):2530-41. doi: 10.1016/j.clinph.2004.05.025.

  PMID: 15465443 BACKGROUND

• Stern WM, Tormos JM, Press DZ, Pearlman C, Pascual-Leone A. Antidepressant effects of high and low frequency repetitive transcranial magnetic stimulation to the dorsolateral prefrontal cortex: a double-blind, randomized, placebo-controlled trial. J Neuropsychiatry Clin Neurosci. 2007 Spring;19(2):179-86. doi: 10.1176/jnp.2007.19.2.179.

  PMID: 17431065 BACKGROUND

• Rektorova I, Sedlackova S, Telecka S, Hlubocky A, Rektor I. Dorsolateral prefrontal cortex: a possible target for modulating dyskinesias in Parkinson's disease by repetitive transcranial magnetic stimulation. Int J Biomed Imaging. 2008;2008:372125. doi: 10.1155/2008/372125.

  PMID: 18274665 BACKGROUND

• Epstein CM, Evatt ML, Funk A, Girard-Siqueira L, Lupei N, Slaughter L, Athar S, Green J, McDonald W, DeLong MR. An open study of repetitive transcranial magnetic stimulation in treatment-resistant depression with Parkinson's disease. Clin Neurophysiol. 2007 Oct;118(10):2189-94. doi: 10.1016/j.clinph.2007.07.010. Epub 2007 Aug 21.

  PMID: 17714987 BACKGROUND

MeSH Terms

Conditions

Supranuclear Palsy, Progressive; Corticobasal Degeneration; Parkinsonian Disorders

Condition Hierarchy (Ancestors)

Basal Ganglia Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Movement Disorders; Ophthalmoplegia; Ocular Motility Disorders; Cranial Nerve Diseases; Tauopathies; Neurodegenerative Diseases; Paralysis; Neurologic Manifestations; Eye Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Allan Wu, M.D.

  UCLA Neurology

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PhD

Study Record Dates

• First Submitted: July 28, 2010
• First Posted: August 4, 2010
• Study Start: October 1, 2008
• Primary Completion: December 1, 2011
• Study Completion: February 1, 2012
• Last Updated: May 8, 2014

Record last verified: 2014-05

Locations

US (1)