A Pilot Study to Assess the Effects of Pre-SMA LF-rTMS for the Treatment of Essential Tremor

Medical University of South Carolina (MUSC)

Status: Completed

Conditions: Essential Tremor

Treatments: Device: eSHAM system; Device: MagVenture MagProx100 Stimulator with a Cool-B65 A/P coil

Study type: Interventional

Funder types: Other

Identifiers

NCT02763865

Pro00033680

Details and patient eligibility

About

The purpose of this study is to determine the effects of Low Frequency Repetitive Transcranial Magnetic Stimulation (LF r-TMS) of the pre-Supplementary Motor Area (pre-SMA) on tremor as measured by the tremor rating scale (TRS) in patients with Essential Tremor (ET).

Hypothesis: Pre-SMA LF r-TMS will result in a >30% reduction in tremor as measured by the TRS. Another purpose of this study is to identify the mechanism by which LF r-TMS of the pre-SMA effects tremor in patients with ET.

Hypothesis: Inhibition of the pre-SMA by LF r-TMS improves tremor in ET by normalizing pre-SMA output, and improving motor control, as determined shortening of the delay in the second agonist burst, seen in ET patients. At conclusion of this study expect to have sufficient pilot data to justify larger pivotal trials designed to establish the efficacy of pre-SMA r-TMS in ET.

Enrollment: 10 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Greater than 18 of age
• Meet the diagnostic criteria for essential tremor with visible upper limb tremor
• Must be either on stable medications to treat tremor for 30 days, or no medications to treat tremor

Exclusion criteria

• History of seizures

• History of chronic pain conditions

• Any metal in their body above their shoulders

• Use of medications that lower seizure threshold including:

  • broad classes of drugs such as tricyclic antidepressants
  • anti-psychotics
  • neuroeptics
  • thyroid medications and stimulants

• Use of any medications that cause tremor, Pregnancy

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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10 participants in 2 patient groups

Active pre-SMA rTMS

Experimental group

Description:

The intervention to be administered is the MagVenture MagProx100 Stimulator with a Cool-B65 A/P coil l to administer active rTMS at 1Hz, 1,200sec, 110% resting motor threshold (rMT); 1200 pulses total. Two Thymapad Stimulus Electrodes will be placed in the appropriate position during active rTMS administration.This intervention method will be used for all 15 treatment sessions (20 minutes/session).

Treatment:

Device: MagVenture MagProx100 Stimulator with a Cool-B65 A/P coil

Sham pre-SMA rTMS

Sham Comparator group

Description:

The intervention to be administered is the eSHAM system used in conjunction with the MagVenture MagProx100 Stimulator with the Cool-B65 A/P Coil. For eSHAM administration two Thymapad Stimulus Electrodes will be placed on the scalp location that corresponded to left DLPFC. This intervention method will be used for all 15 treatment sessions (20 minutes/session). Previous studies have shown the eSHAM system effectively blinds participants to rTMS treatment (active versus sham).

Treatment:

Device: eSHAM system