Transcranial Magnetic Stimulation in Stroke Motor Rehabilitation Treatment

Emory University

Status: Not yet enrolling

Conditions: Stroke

Treatments: Device: Repetitive TMS over contralateral premotor cortex.; Device: Single TMS over extensor carpi ulnaris spot of motor cortex; Device: Repetitive TMS over contralateral primary motor cortex.; Device: Repetitive TMS over ipsilateral premotor cortex.; Device: Sham Repetitive TMS over contralateral premotor cortex.

Study type: Interventional

Funder types: Other

Identifiers

NCT03268070

IRB00097855

Details and patient eligibility

About

The goal of the study is to determine the effect of repetitive transcranial magnetic stimulation (rTMS) over the premotor cortex on training-related improvements in motor performance and associated neural plasticity.

Full description

Occlusion of the middle cerebral artery is the most common cause of stroke. Because the middle cerebral artery supplies blood to the motor cortices, middle cerebral artery stroke often impacts the integrity of the motor cortex and its associated corticospinal projections. Less than half of all individuals post-stroke regain complete motor function. Because motor deficits, especially of the upper extremities, can dampen the quality of life, there is an urgent need to improve current rehabilitation programs to allow more stroke survivors to achieve higher functional gains.

Motor training is an important part of recovery after stroke. During motor training, patients practice performing a movement and become better at performing the trained movement over time. Repetitive transcranial magnetic stimulation (rTMS), which uses magnetism to excite neurons near the surface of the brain, may further improve performance. There is evidence that the premotor cortex may be a more effective target than the primary motor cortex for rTMS for some stroke survivors. In the current study, the investigator will determine the effect of rTMS over the premotor cortex on training-related improvements in motor performance in adults who experienced a stroke more than 6 months ago.

Enrollment: 70 estimated patients

Sex: All

Ages: 30 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Have the ability to give informed, written consent

• Be aged 30-80 years old

• Have a single ischemic infarction affecting the primary motor system

• Have intact cognitive abilities

• No current depression

• No neurological disease

• No contradictions to TMS

  • No history of seizures or epilepsy
  • No implanted medical device
  • No metal in neck or head
  • No history of migraine headaches
  • No intake of medication that lowers seizure threshold

Exclusion criteria

• none

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Double Blind

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70 participants in 5 patient groups

Repetitive TMS over contralateral premotor cortex

Experimental group

Description:

Location of repetitive Transcranial Magnetic Stimulation (rTMS): contralateral premotor cortex.

Treatment:

Device: Repetitive TMS over contralateral premotor cortex.

Repetitive TMS over ipsilateral premotor cortex

Experimental group

Description:

Location of repetitive Transcranial Magnetic Stimulation (rTMS): ipsilateral premotor cortex.

Treatment:

Device: Repetitive TMS over ipsilateral premotor cortex.

Repetitive TMS over contralateral primary motor cortex

Experimental group

Description:

Location of repetitive Transcranial Magnetic Stimulation (rTMS): contralateral primary motor cortex.

Treatment:

Device: Repetitive TMS over contralateral primary motor cortex.

Sham repetitive TMS over contralateral premotor cortex

Sham Comparator group

Description:

Location of Sham repetitive Transcranial Magnetic Stimulation (rTMS): contralateral premotor cortex.

Treatment:

Device: Sham Repetitive TMS over contralateral premotor cortex.

Single TMS over extensor carpi ulnaris spot of motor cortex

Experimental group

Description:

Location of single-pulse Transcranial Magnetic Stimulation (sTMS): extensor carpi ulnaris (ECU) hotspot of primary motor cortex (M1).

Treatment:

Device: Single TMS over extensor carpi ulnaris spot of motor cortex