Dynamic Individualized rTMS Based on fNIRS

• Sponsor: First Affiliated Hospital Xi'an Jiaotong University (Other)
• Overall Status: Recruiting
• CT.gov ID: NCT04617366
• Collaborator: (none)
• Enrollment: 50
• Location: 1
• Arms: 2
• Anticipated Duration (Months): 40.8
• Patients Per Site Per Month: 1.2

Study Details

Study Description

Brief Summary

Stroke patients do not respond well to the traditional repetitive transcranial magnetic stimulation (rTMS) strategy based on the competitive model. The studies found that the contralesional motion cortex has a compensatory effect on the realization of the motor function of the affected side-the compensatory model, and the degree of compensation will change as the function changes. The optimal neural regulation strategies under different models are opposite, so it is important to accurately evaluate which of the two models plays the leading role. And functional near-infrared spectroscopy (fNIRS) may accurately and quickly assess cortical function in order to determine the degree of participation of the contralesional motion cortex. We propose that the dynamic individualized strategy which adjust the rTMS parameters promptly based on the results of fNIRS will be better than the traditional stimulation strategy. This project will apply a blinded-assessment randomized controlled trial. The test group selects either the high-frequency rTMS to the contralesional dorsal premotor cortex (PMd) or the low-frequency rTMS to the contralesional primary motor cortex (M1) based on the lateralization index of the PMd measured by fNIRS. And the control group will always be given low-frequency rTMS to contralesional M1. The difference in the improvement of upper limb function between the two groups of patients was compared.

Condition or Disease	Intervention/Treatment	Phase
Stroke; Rehabilitation; Repetitive Transcranial Magnetic Stimulation; Functional Near-infrared Spectroscopy	Other: Individualized rTMS strategy; Other: Traditional rTMS strategy	N/A

Study Design

• Study Type: Interventional
• Anticipated Enrollment: 50 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Effect of Dynamic Individualized rTMS Based on fNIRS on Upper Limb Function of Stroke Patients
• Actual Study Start Date: Nov 5, 2020
• Anticipated Primary Completion Date: Dec 31, 2023
• Anticipated Study Completion Date: Mar 31, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Individualized rTMS strategy The individualized strategy will adjust the rTMS parameters promptly based on the results of fNIRS. This arm selects either the high-frequency rTMS to the contralesional dorsal premotor cortex (PMd) or the low-frequency rTMS to the contralesional primary motor cortex (M1) based on the lateralization index of the PMd measured by fNIRS.	Other: Individualized rTMS strategy; It will adjust the rTMS parameters based on the results of fNIRS.
Active Comparator: Traditional rTMS strategy The control group will always be given low-frequency rTMS to contralesional M1.	Other: Traditional rTMS strategy; The patients will always be given low-frequency rTMS to contralesional M1.

Outcome Measures

Primary Outcome Measures

1. Fugl-Meyer motor function score of upper limb [3 months]

   The score range is 0-66 points, the higher the score, the better the motor function of upper limb.

Secondary Outcome Measures

1. Barthel index [3 months]

   The score range is 0-100 points, the higher the score, the better the activities of daily living.

2. Lateralization index (LI) [3 months]

   The LI score measured by fNIRS ranges from -1 to 1, with 1 indicating purely ipsilesional and -1 indicating purely contralesional activation.

3. Brain functional connection network [3 months]

   Using fNIRS to analyze the functional connection network between the motor areas of the bilateral cerebral hemispheres.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 40 Years to 79 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Aged 40-79 years;

• Patients with first-onset subcortical infarcts within1 to 3 weeks after onset;

• TMS on the lesion side can induce motor evoked potential(MEP) of the abductor pollicis brevis muscle of the affected hand;

• Consciousness, sitting balance level 1 or above, can cooperate with assessment and treatment;

• The patient or its authorized agent signs the informed consent form.

Exclusion Criteria:

• Previous seizures;

• Suffered from mental illness such as depression, anxiety, mania, and schizophrenia before the stroke onset;

• Patients with metal on the head, cochlear implants, intracranial infections, etc. who are not suitable for rTMS.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	The First Affiliated Hospital of Xi'an Jiaotong University	Xi'an	Shaanxi	China	710000

Sponsors and Collaborators

• First Affiliated Hospital Xi'an Jiaotong University

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: First Affiliated Hospital Xi'an Jiaotong University
• ClinicalTrials.gov Identifier: NCT04617366
• Other Study ID Numbers: XJUFH-R-002
• First Posted: Nov 5, 2020
• Last Update Posted: Feb 23, 2022
• Last Verified: Feb 1, 2022

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Additional relevant MeSH terms: Stroke

Study Results

No Results Posted as of Feb 23, 2022