Repetitive Transcranial Magnetic Stimulation for the Treatment of Focal Hand Dystonia

University of Minnesota (UMN)

Status and phase: Completed; Phase 1

Conditions: Dystonia, Focal, Task-specific

Treatments: Device: Sham rTMS; Device: rTMS

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01884064

M01RR000400 (U.S. NIH Grant/Contract)

0608M91226

Details and patient eligibility

About

This study investigated the short term effects of repeated administrations of repetitive-transcranial magnetic stimulation (rTMS) on clinical changes and investigate neurophysiologic responses to rTMS of the activated motor system in patients with FHD.

Full description

Purpose: The ability of low-frequency repetitive transcranial magnetic stimulation (rTMS) to enhance intracortical inhibition has motivated its use as a potential therapeutic intervention in focal hand dystonia (FHD). In this preliminary investigation, we assessed the physiologic and behavioral effects of multiple sessions of rTMS in FHD. Methods: 12 patients with FHD underwent five daily-sessions of 1 Hz rTMS to contralateral dorsal premotor cortex (dPMC). Patients held a pencil and made movements that did not elicit dystonic symptoms during rTMS. We hypothesized that an active but non-dystonic motor state would increase beneficial effects of rTMS. Five additional patients received sham-rTMS protocol. The area under curve (AUC) of the motor evoked potentials and the cortical silent period (CSP) were measured to assess changes in corticospinal excitability and intracortical inhibition, respectively. Behavioral measures included pen force and velocity during handwriting and subjective report.

Enrollment: 17 patients

Sex: All

Ages: 21 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Task specific Focal Hand Dystonia

Exclusion criteria

• any neurologic condition other than FHD
• medication for dystonia
• botulinum toxin within the past three months
• seizure history
• pregnancy
• implanted medical devices

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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17 participants in 2 patient groups, including a placebo group

inhibitory rTMS

Experimental group

Description:

Repetitive Transcranial Magnetic stimulation: 1 Hz rTMS, 1800 pulses, delivered to premotor cortex. Patients held a pencil and made movements that did not elicit dystonic symptoms during rTMS. Intervention was delivered every day for 5 days.

Treatment:

Device: rTMS

Sham rTMS

Placebo Comparator group

Description:

Sham Repetitive Transcranial Magnetic stimulation: 1 Hz rTMS, 1800 pulses, delivered to premotor cortex. Patients held a pencil and made movements that did not elicit dystonic symptoms during rTMS. Intervention was delivered every day for 5 days.

Treatment:

Device: Sham rTMS