Effects of Prism Adaption and rTMS on Brain Connectivity and Visual Representation

Sponsor

National Institute of Neurological Disorders and Stroke (NINDS) (NIH)

Overall Status

Completed

CT.gov ID

NCT02911129

Collaborator

(none)

Enrollment

Location

42.1

Actual Duration (Months)

1.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Background:

After a stroke, the balance between the two halves of the brain can be lost. This may cause people to lose the ability to perceive a side of space. This is called neglect. Having people wear prism glasses (called PA) can reduce neglect symptoms. Researchers want to find out more about how PA, and whether it restores the balance in the brain.

Objective:

To learn how prism adaption temporarily changes vision and connections in the brain.

Eligibility:

People ages 18 75 with brain damage of the right side of the brain from a stroke or other cause, leading to neglect.

Healthy volunteers ages 18 75.

Design:

Participants will have 1 3 visits.

Participants will be screened with a neurological exam. They may also have:

Tests of thinking and vision

Tests to see which eye and hand they prefer

A pregnancy test

All participants will:

Answer questions about their personality, style of thinking, and beliefs.

Do simple tasks on paper or computer

Have magnetic resonance imaging. They will lie on a table that can slide in and out of a cylinder in a strong magnetic field. Participants will lie still or do computer tasks in the scanner.

Participants may also have:

Transcranial magnetic stimulation. A brief electrical current passes through a wire coil on the scalp. This creates a magnetic pulse that affects brain activity. Participants may be asked to tense certain muscles or perform simple actions or tasks.

PA. They will sit in front of a board and point to a dot on it while they wear prism glasses that shift vision to the left or right.

Condition or Disease	Intervention/Treatment	Phase
Normal Physiology Stroke

Detailed Description

OBJECTIVES:

The ability to efficiently select information from the environment relies on a balanced interaction between the right and left hemispheres. Hemispatial neglect, most frequently following damage to the right hemisphere, has been hypothesized to result from the breakdown of this interhemispheric balance. There is evidence from transcranial stimulation studies that the breakdown of this interhemispheric balance is reflected in fronto-parietal connectivity. The primary goal of this study is to test whether altering the balance between the left and right hemispheres, with repetitive transcranial magnetic stimulation (rTMS) or prism adaptation (PA), will affect functional connectivity measured with functional magnetic resonance imaging (fMRI). We will also explore the relationship between the changes in functional connectivity and behavioral performances.

STUDY POPULATION: Healthy adult volunteers and patients with neglect after a right hemisphere damage.

DESIGN: The study contains three experiments. Experiment 1 is designed to investigate the mechanism of the changes induced by PA in both resting state functional connectivity in neglect patients and healthy volunteers (a two-arm parallel study). Experiment 2 is designed to investigate the mechanism of the changes in resting state functional connectivity induced by lPA, rPA, nPA in healthy volunteers with right dominant eyes and lPA in healthy volunteer with left dominant eye (a four-arm parallel study). Experiment 3 is designed to see if inhibitory rTMS over the right posterior parietal cortex (PPC) can influence functional connectivity and visuospatial bias in healthy volunteers (a crossover study).

OUTCOME MEASURES: For all three experiments the primary outcome measure is the change (or difference) in fronto-parietal resting state connectivity between post and pre PA or rTMS procedure. The secondary outcome measures are the changes in visual field representation and in visuo-motor and cognitive behavior accompanying these manipulations.

Study Design

Study Type:

Observational

Actual Enrollment :

74 participants

Observational Model:

Cohort

Time Perspective:

Prospective

Official Title:

Effects of Prism Adaption and rTMS on Brain Connectivity and Visual Representation

Actual Study Start Date :

Nov 4, 2016

Actual Primary Completion Date :

Dec 21, 2018

Actual Study Completion Date :

May 7, 2020

Arms and Interventions

Arm	Intervention/Treatment
Healthy Volunteer Inclusion Criteria for Healthy Volunteers/Age-matched Controls
Patients Patients with neglect after a right hemisphere brain lesion

Outcome Measures

Primary Outcome Measures

Experiment 1: The primary outcome measure will be the change in the strength of the fronto-parietal resting state network (RSN) after rPA in neglect patients. [1 week]
Measurement of Change
Experiments 2: The primary outcome measure will be the change in the strength of the fronto-parietal resting state network (RSN) after rPA or lPA or nPA. [1 week]
Measurement of change
Experiment 3: The primary outcome measure will be the change in the strength of the fronto-parietal resting state network (RSN) after cTBS over the PPC versus cTBS over the vertex. [3 weeks]
Measurement of change

Secondary Outcome Measures

Experiment 1: The change of preferred center and size in the different region of interest (ROI) in the parietal cortex, and the change in open loop pointing task performances after rPA. [1 week]
Observation of changeExperiment 1: The change of preferred center (visual field location) and size (visual field extent) (i.e. population receptive field) in the different region of interest (ROI) in the parietal cortex, and the change in open loop pointing task performances after rPA.
Experiments 2: The change of preferred center and sizein the different region of interest (ROI) in the parietal cortex, and the change in open loop pointing task performances after rPA or lPA, or nPA [1 week]
Observation of changeExperiments 2: The change of preferred center (visual field location) and size (visual field extent) (i.e. population receptive field) in the different region of interest (ROI) in the parietal cortex, and the change in open loop pointing task performances after rPA or lPA, or nPA
Experiments 3: The change in perceptual line bisection performances after r cTBS over PPC or cTBS over the vertex. [1 week]
Oberservation of change

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 75 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

INCLUSION CRITERIA:

Inclusion Criteria for all participants:

All participants must have had a neurological examination by a NINDS physician within the last two years, a clinical MRI within the last year, and be able to read, write and speak English.

Experiment 2 requires 63 healthy volunteers having right dominant eye and 21 volunteers having left dominant eye. Therefore, healthy volunteers with left dominant eye will be recruited until the necessary number is reached. We estimate we will have to screen 150

healthy volunteers. Participants for whom the study was not completed due to technical problems and who did not undergo prism adaptation or TMS will be retested and data from the incomplete session will not be analyzed.

A-Inclusion Criteria for Healthy volunteers/Age-matched Controls

Experiment 1

Age 18-75 (inclusive; we will try to match this to the stroke group)
Montreal Cognitive Assessment score greater than or equal to 26
Absence of neglect at time of testing (Diller test score less than or equal to 2)

Experiments 2 and 3

Right-handedness
Age 18-35 (inclusive)
Twelve or more years of education
Are able to see a dot of size 0.2 inches at a distance of 22.5 inches without glasses or with contact lenses (only for Experiment 2)

B-Inclusion Criteria for Patients

Experiment 1

Age 18-75 (inclusive)
Montreal Cognitive Assessment score greater than or equal to 26
A right hemisphere stroke or other focal, non-progressive, brain lesion resulting in neglect
Minimum of 30 days from lesion onset to testing
Evidence of neglect at time of testing (Diller test score greater than or equal to 5)

EXCLUSION CRITERIA:

A- Exclusion Criteria for Healthy volunteers

Significant illness affecting the central nervous system
History of seizure (for Experiment 3)
Inability to give informed consent
Concurrent use of sedating medications
Trained to write in other than left to right direction
Ferromagnetic metal in the cranial cavity or eye, e.g. aneurysm clip, implanted neural stimulator, cochlear implant, or ocular foreign body
Implanted cardiac pacemaker or auto-defibrillator or pump
Non-removable body piercing
Claustrophobia
Inability to lie supine for 1.5 hour
Pregnancy
Members of the NINDS Behavioral Neurology Unit (BNU)

B- Exclusion Criteria for Patients and Age-matched Controls:

Significant illness affecting the central nervous system, other than right hemisphere lesion causing neglect in patients
Inability to give informed consent
Concurrent use of sedating medications
Ferromagnetic metal in the cranial cavity or eye, e.g. aneurysm clip, implanted neural stimulator, cochlear implant, or ocular foreign body
Implanted cardiac pacemaker or auto-defibrillator or pump
Non-removable body piercing
Claustrophobia
Inability to lie supine for 1.5 hour
Pregnancy
Members of the NINDS Behavioral Neurology Unit (BNU)