Niche Trial: Navigated Inhibitory rTMS to Contralesional Hemisphere Trial

Completed · Not applicable · Has a placebo group

Conditions studied: Stroke

In brief

A pivotal, prospective, multi-center, randomized, controlled, double-blinded study combining active Nexstim NBS-guided 1Hz rTMS or sham-rTMS targeting the healthy hemisphere with standardized task oriented rehabilitation will be conducted in patients with post-stroke motor impairment. The therapy will be provided for 6 weeks and primary outcome assessed 6 months later.

Key facts

Study ID

NCT02089464

Run by

Nexstim Ltd

People needed

199

Starts

2014-04-01

Expected to finish

2016-05-01

Last updated by the study team

2020-09-01

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• ≥ 18 years of age
• An ischemic or hemorrhagic stroke suffered 3-12 months prior to the study;
• no other known brain abnormalities by history;
• A one-sided stroke resulting in upper extremity paresis
• A Chedoke-McMaster Stroke Assessment arm stage and hand stage of 3-6 for the affected limb

You may not qualify if…

• Implanted metallic parts of implanted electronic devices, including pacemakers, defibrillators, or implant medication pump;
• Pregnant or trying to become pregnant; Lack of pregnancy established in females of child-bearing potential by a negative urine pregnancy test at screening.
• Active alcohol abuse, illicit drug use or drug abuse or significant mental illness
• Patients suffering from depression as measured by a score of >10 on the Patient Health Questionnaire (PHQ9). For clarity, patients diagnosed with depression which is controlled with stable anti-depressive medication and in whom PHQ9 is <10 are eligible to participate in the trial.
• History of epilepsy, defined as at least two unprovoked seizures occurring greater than 24 hours apart or diagnosis of an epilepsy syndrome, OR a seizure within the last 12 months.
• Any condition that would prevent the subject from giving voluntary informed consent;
• An implanted brain stimulator;
• Any metal in head with the exception of dental work or any ferromagnetic metal elsewhere in the body;
• Enrolled or plans to enroll in an interventional trial during this study;
• Scalp wounds or infections;
• Claustrophobia precluding MRI;
• A fixed contraction deformity in the affected limb that would prevent normal dexterity if patient were neurologically intact;
• Excessive spasticity as indicated by the Modified Ashworth Spasticity (MAS) Scale >2/4 in either elbow flexors, wrist flexors or finger flexors of the affected limb;i
• previous stroke with residual deficits (TIAs not a reason for exclusion);
• premorbid (retrospective) modified Rankin Scale (mRS) score ≥2 of any aetiology;
• a concurrent progressive neurologic disorder, acute coronary syndrome, severe heart disease (NYHA Classification > 3), or other major medical condition,
• confirmed or suspected lower-limb fracture preventing mobilization,
• patients requiring palliative care
• patients planning to undergo any other occupational therapy during the 6 week active treatment period of the trial (see section 5.2 for study schedule) than what is provided in the study
• A recent injection of botulinium toxin to the affected upper limb in the last 3 months, or the need of an injection of botulinum toxin anytime during the study period and follow up.
• A recent injection of phenol to the affected upper limb in the last 6 months, or the need of an injection of phenol anytime during the study period and follow up.
• Ataxia as measured by a score > 1 on item 7 (limb ataxia) of the NIH stroke scale.
• Severe sensory deficits as measured by a score of 2 on item 8 of the NIH stroke scale.
• Severe aphasia as measured by a score of > 2 on item 9 (best language) of the NIH stroke scale.
• Severe neglect as measured by a score of 2 on item 11 (extinction and inattention) of the NIH stroke scale.

Where it is running

• Mayo Clinic — Phoenix, Arizona, United States
• Rancho Los Amigos National Rehabilitation Center — Downey, California, United States
• Shepherd Rehabilitation Center — Atlanta, Georgia, United States
• Rehabilitation Institute of Chicago — Chicago, Illinois, United States
• Indiana University Indianapolis — Indianapolis, Indiana, United States
• Spaulding Rehabilitation Hospital — Boston, Massachusetts, United States
• Columbia Cornell New York Presbyterian Hospital — New York, New York, United States
• Burke Medical Research Institute, Weill Cornell Neurology — White Plains, New York, United States
• Duke University Medical Center — Durham, North Carolina, United States
• University of Cincinnati — Cincinnati, Ohio, United States
• Ohio State University — Columbus, Ohio, United States
• TIRR Memorial Hermann Hospital — Houston, Texas, United States

Full record on ClinicalTrials.gov

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