Amyotrophic Lateral SclerosisPhase 2/3rTMS-ALSNCT00833820
Repetitive Transcranial Magnetic Stimulation (rTMS) in Amyotrophic Lateral Sclerosis
A Phase 2/3 study testing Real rTMS of the brain in people with Amyotrophic Lateral Sclerosis, run by Catholic University of the Sacred Heart at 1 site in Italy.
Trial summary
The investigators' preliminary studies demonstrated that repetitive transcranial magnetic stimulation (rTMS) of the brain may determine a slight slowing in the rate of disease progression in ALS patients (Di Lazzaro et al 2004, 2006). Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Amyotrophic Lateral Sclerosis
- What is being tested?
- Real rTMS of the brain
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 20 participants
- Where
- 1 siteItaly
- Study dates
- May 2007to Dec 2008
- Phase
- Phase 2/3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- Eligible patients should have a diagnosis of definite ALS according to the El Escorial revised criteria with clear clinical upper and lower motor neuron signs.
Who cannot join
- Contraindications to transcranial magnetic stimulation:
- Tracheostomy
- Pace-maker
- Implanted metallic devices
- Epilepsy
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Repetitive Transcranial Magnetic Stimulation in Amyotrophic Lateral Sclerosis
The investigators' preliminary studies demonstrated that repetitive transcranial magnetic stimulation (rTMS) of the brain may determine a slight slowing in the rate of disease progression in ALS patients (Di Lazzaro et al 2004, 2006). The aim of this study is to investigate whether rTMS of the motor cortex performed over a long period of time (12 months) in a group of patients with ALS, can have a more pronounced beneficial effect. The investigators will compare the disease progression in two groups of patients: the first group of patients will be treated with real rTMS (one week daily treatment every month) and the second group of patients will be treated with sham (placebo) rTMS.
Read the detailed description
Eligible patients should have a diagnosis of definite ALS according to the El Escorial revised criteria with clear clinical upper and lower motor neuron signs. Twenty patients with definite ALS will be enrolled and will be allocated to the treatment: 10 active and 10 sham stimulation. Patients will be randomly allocated by one of the investigators not involved in follow-up evaluations and data analysis. Stratified block randomisation will be performed such that the two treatment groups will be evenly balanced for disease severity, as evaluated with the revised ALS functional rating scale (ALSFRS-R), and duration. The patients and the neurologists assessing the outcomes will be blinded to group assignment.
Outcome measures Patients will be evaluated at the beginning of the treatment and every month until the end of the study at 1 year. At each visit, patients will be evaluated using the ALSFRS-R and manual muscle testing (MMT). MMT testing will be performed by means of the Medical Research Council (MRC) Scale. To obtain an estimate of the overall limb muscle strength we will calculate a MRC compound score by adding the MRC scores of eight upper limb muscles and five lower limb muscles for each side and dividing the sum by the number of muscles tested (26 muscles). We will test the following muscles: biceps brachii, deltoid, triceps brachii, extensor carpi radialis , extensor digitorum communis, abductor digiti minimi, abductor pollicis brevis, opponens pollicis, iliopsoas, rectus femoris, tibialis anterior, extensor hallucis longus, gastrocnemius.
The primary outcome measure will be the rate of decline of ALSFRS-R scores. Secondary outcome measure will be the rate of decline in MMT.
Transcranial brain stimulation Central motor conduction time for the first dorsal interosseous muscle will calculated by subtracting the peripheral conduction time, from spinal cord to muscles, from the latency of responses evoked by cortical stimulation at the maximum stimulator output during voluntary contraction at about 20% of maximum.
Repetitive TMS will be applied over the hand motor area using a MagPro (Medtronic A/S Denmark) stimulator and a figure of eight-shaped coil.
Active rTMS will be performed using the cTBS pattern in which 3 pulses of stimulation are given at 50Hz, repeated every 200 ms for a total of 600 pulses. We will use a butterfly coil (MCF-B-65) with the handle pointed posteriorly and approximately perpendicular to the central sulcus. The initial direction of the current induced in the brain will be posterior-anterior. The stimulation intensity will be 80 % of the active motor threshold (AMT), defined as the minimum single pulse intensity required to produce a motor evoked potential greater than 200 uV on more than five out of ten trials from the contracted contralateral first interosseous muscle. This protocol leads to pronounced and prolonged suppression of cortical excitability that reaches a maximum about 5-10 min after the end of the stimulation.
Sham rTMS will be performed using the same stimulator connected to the placebo butterfly coil MCF-P-B-65 which has no stimulating effect on the cortex but produces similar auditory and tactile sensations as the active coil. The site of stimulation and the number of stimuli will be identical to those used for the active magnetic rTMS.
Repetitive TMS will be performed bilaterally. The order of stimulation of the two hemispheres will be randomized. The stimulation of the two hemispheres will be performed sequentially at an interval of one minute. The motor cortex of each side will be stimulated for five consecutive days every month for twelve consecutive months. In the patients with absent first dorsal interosseous motor evoked potentials after stimulation of one hemisphere, the repetitive stimulation will be performed at the same intensity used for the opposite hemisphere.
Statistical analysis Statistical analysis will be performed using a two-factor (TIME and TREATMENT) repeated measures analysis of variance.
- Conditions
- Amyotrophic Lateral Sclerosis
- Being tested
- Real rTMS of the brain, Sham rTMS of the brain
- Keywords
- ALS, transcranial brain stimulation
- Medical subject headings
- Amyotrophic Lateral Sclerosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Real rTMS of the brainProcedure or surgery
Repetitive transcranial magnetic stimulation will be performed using a focal coil held over motor cortex on each hemisphere. Stimulation protocol used will be the cTBS in which three pulses of stimulation are given at 50 Hz, repeated every 200 ms for a total of 300 pulses delivered over the right motor cortex. The stimulus intensity will be set at 80% of Action Motor Threshold.
Sham rTMS of the brainProcedure or surgery
Sham repetitive transcranial magnetic stimulation will be performed using the same stimulator connected to the placebo butterfly coil MCF-P-B-65 which has no stimulating effect on the cortex but produces similar auditory and tactile sensations as the active coil. The site of stimulation and the number of stimuli will be identical to those used for the active magnetic rTMS.
| Study group | Role | What they receive |
|---|---|---|
| A | Active comparator | Patients receiving real rTMS Receives: Procedure: Real rTMS of the brain |
| B | Sham comparator | patients receiving sham stimulation Receives: Procedure: Sham rTMS of the brain |
What is being measured
The primary outcome is the main question the study is designed to answer.
Rate of decline of ALSFRS-R score
Measured: one year
Secondary outcomes (1)
Rate of decline of manual muscle force testing score
Measured: one year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Feb 2009 (estimated)
- Study startMay 2007
- Primary completionDec 2008
- Study completionDec 2008
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Amyotrophic Lateral SclerosisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2/3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 20 participants (actual)
Sponsor and investigators
- Lead sponsor
- Catholic University of the Sacred Heart
- Sponsor type
- University, hospital or other
- Investigators
- Vincenzo Di Lazzaro, MD, Principal investigator, Institute of Neurology Università Cattolica Roma
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00833820
- Sponsor's protocol ID
- 001
- Acronym
- rTMS-ALS
- Status last verified
- Jan 2009
- First submitted
- 30 Jan 2009
- Last updated
- 2 Feb 2009
- Results posted
- No
- Data monitoring committee
- No
Publications
Di Lazzaro V, Pilato F, Profice P, Ranieri F, Musumeci G, Florio L, Beghi E, Frisullo G, Capone F, Sabatelli M, Tonali PA, Dileone M. Motor cortex stimulation for ALS: a double blind placebo-controlled study. Neurosci Lett. 2009 Oct 16;464(1):18-21. doi: 10.1016/j.neulet.2009.08.020. Epub 2009 Aug 12.
PubMed 19682544
Study at a glance
From the registry record, last updated by the sponsor on 2 Feb 2009. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Repetitive Transcranial Magnetic Stimulation in Amyotrophic Lateral Sclerosis
- ClinicalTrials.gov ID
- NCT00833820
- Acronym / sponsor ID
- rTMS-ALS / 001
- Conditions
- Amyotrophic Lateral Sclerosis
- Keywords
- ALS, transcranial brain stimulation
- Phase
- Phase 2/3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 20 participants (actual)
- Lead sponsor
- Catholic University of the Sacred HeartUniversity, hospital or other
- Study start
- May 2007
- Primary completion
- Dec 2008 (actual)
- Study completion
- Dec 2008 (actual)
- First posted
- 2 Feb 2009 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The investigators' preliminary studies demonstrated that repetitive transcranial magnetic stimulation (rTMS) of the brain may determine a slight slowing in the rate of disease progression in ALS patients (Di Lazzaro et al 2004, 2006). The aim of this study is to investigate whether rTMS of the motor cortex performed over a long period of time (12 months) in a group of patients with ALS, can have a more pronounced beneficial effect. The investigators will compare the disease progression in two groups of patients: the first group of patients will be treated with real rTMS (one week daily treatment every month) and the second group of patients will be treated with sham (placebo) rTMS.
Detailed description
Eligible patients should have a diagnosis of definite ALS according to the El Escorial revised criteria with clear clinical upper and lower motor neuron signs. Twenty patients with definite ALS will be enrolled and will be allocated to the treatment: 10 active and 10 sham stimulation. Patients will be randomly allocated by one of the investigators not involved in follow-up evaluations and data analysis. Stratified block randomisation will be performed such that the two treatment groups will be evenly balanced for disease severity, as evaluated with the revised ALS functional rating scale (ALSFRS-R), and duration. The patients and the neurologists assessing the outcomes will be blinded to group assignment.
Outcome measures Patients will be evaluated at the beginning of the treatment and every month until the end of the study at 1 year. At each visit, patients will be evaluated using the ALSFRS-R and manual muscle testing (MMT). MMT testing will be performed by means of the Medical Research Council (MRC) Scale. To obtain an estimate of the overall limb muscle strength we will calculate a MRC compound score by adding the MRC scores of eight upper limb muscles and five lower limb muscles for each side and dividing the sum by the number of muscles tested (26 muscles). We will test the following muscles: biceps brachii, deltoid, triceps brachii, extensor carpi radialis , extensor digitorum communis, abductor digiti minimi, abductor pollicis brevis, opponens pollicis, iliopsoas, rectus femoris, tibialis anterior, extensor hallucis longus, gastrocnemius.
The primary outcome measure will be the rate of decline of ALSFRS-R scores. Secondary outcome measure will be the rate of decline in MMT.
Transcranial brain stimulation Central motor conduction time for the first dorsal interosseous muscle will calculated by subtracting the peripheral conduction time, from spinal cord to muscles, from the latency of responses evoked by cortical stimulation at the maximum stimulator output during voluntary contraction at about 20% of maximum.
Repetitive TMS will be applied over the hand motor area using a MagPro (Medtronic A/S Denmark) stimulator and a figure of eight-shaped coil.
Active rTMS will be performed using the cTBS pattern in which 3 pulses of stimulation are given at 50Hz, repeated every 200 ms for a total of 600 pulses. We will use a butterfly coil (MCF-B-65) with the handle pointed posteriorly and approximately perpendicular to the central sulcus. The initial direction of the current induced in the brain will be posterior-anterior. The stimulation intensity will be 80 % of the active motor threshold (AMT), defined as the minimum single pulse intensity required to produce a motor evoked potential greater than 200 uV on more than five out of ten trials from the contracted contralateral first interosseous muscle. This protocol leads to pronounced and prolonged suppression of cortical excitability that reaches a maximum about 5-10 min after the end of the stimulation.
Sham rTMS will be performed using the same stimulator connected to the placebo butterfly coil MCF-P-B-65 which has no stimulating effect on the cortex but produces similar auditory and tactile sensations as the active coil. The site of stimulation and the number of stimuli will be identical to those used for the active magnetic rTMS.
Repetitive TMS will be performed bilaterally. The order of stimulation of the two hemispheres will be randomized. The stimulation of the two hemispheres will be performed sequentially at an interval of one minute. The motor cortex of each side will be stimulated for five consecutive days every month for twelve consecutive months. In the patients with absent first dorsal interosseous motor evoked potentials after stimulation of one hemisphere, the repetitive stimulation will be performed at the same intensity used for the opposite hemisphere.
Statistical analysis Statistical analysis will be performed using a two-factor (TIME and TREATMENT) repeated measures analysis of variance.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| A | Active comparator | Procedure: Real rTMS of the brainPatients receiving real rTMS |
| B | Sham comparator | Procedure: Sham rTMS of the brainpatients receiving sham stimulation |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (1 listed)
- Eligible patients should have a diagnosis of definite ALS according to the El Escorial revised criteria with clear clinical upper and lower motor neuron signs.
Key exclusion criteria (5 listed)
- Contraindications to transcranial magnetic stimulation:
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Real rTMS of the brainRepetitive transcranial magnetic stimulation will be performed using a focal coil held over motor cortex on each hemisphere. Stimulation protocol used will be the cTBS in which three pulses of stimulation are given at 50 Hz, repeated every 200 ms for a total of 300 pulses delivered over the right motor cortex. The stimulus intensity will be set at 80% of Action Motor Threshold. | Procedure or surgery | A |
| Sham rTMS of the brainSham repetitive transcranial magnetic stimulation will be performed using the same stimulator connected to the placebo butterfly coil MCF-P-B-65 which has no stimulating effect on the cortex but produces similar auditory and tactile sensations as the active coil. The site of stimulation and the number of stimuli will be identical to those used for the active magnetic rTMS. | Procedure or surgery | B |
Primary outcome
Rate of decline of ALSFRS-R score
Time frame: one year
1 secondary outcome
Rate of decline of manual muscle force testing score
Time frame: one year
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Feb 2009.
- Derived from this study: PubMed 19682544Di Lazzaro V, Pilato F, Profice P, Ranieri F, Musumeci G, Florio L, Beghi E, Frisullo G, Capone F, Sabatelli M, Tonali PA, Dileone M. Motor cortex stimulation for ALS: a double blind placebo-controlled study. Neurosci Lett. 2009 Oct 16;464(1):18-21. doi: 10.1016/j.neulet.2009.08.020. Epub 2009 Aug 12.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Vincenzo Di Lazzaro, MD principal investigator
Institute of Neurology Università Cattolica Roma
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2/3 study testing Real rTMS of the brain in people with Amyotrophic Lateral Sclerosis, run by Catholic University of the Sacred Heart at 1 site in Italy.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 2 Feb 2009. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Rate of decline of ALSFRS-R score (time frame: one year). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00833820, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Feb 2009.