Repetitive Transcranial Magnetic Stimulation for the Treatment of Focal Hand Dystonia
Preliminary results demonstrated no significant changes in cortical excitability or handwriting performance following 5 days of rTMS in focal hand dystonia. However, the majority of subjects reported symptom improvement. Previous research using a similar protocol has shown significant changes in cortical excitability and handwriting performance lasting at least 10-days following treatment. Data collection and analysis is currently in progress. Additionally, Impaired inhibition as measured by CSP may be present in people with oromandibular dystonia, which is a similar finding to other focal dystonias. Inhibitory rTMS may be effective in reducing excitability that may improve clinical symptoms of this disorder.
|Study Design:||Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Repetitive Transcranial Magnetic Stimulation for the Treatment of Focal Hand Dystonia|
- Change from baseline in cortical silent period [ Time Frame: Day 5: Post test after intervention. Also at day 15: Followup session 10 days after posttest ] [ Designated as safety issue: No ]Cortical silence period
- Change from baseline in hand writing assessment [ Time Frame: Day 5: Post test after intervention. Also at day 15: Followup session 10 days after posttest ] [ Designated as safety issue: No ]Hand writing assessment of pen pressure (reported in newtons)is a significant limitation for patients with hand dystonia. The efficacy of the intervention is tested with digitized table assessment of handwriting.
- Change from baseline hand writing velocity [ Time Frame: Day 5: Post test after intervention. Also at day 15: Followup session 10 days after posttest ] [ Designated as safety issue: No ]Hand writing velocity (m/s)is a significant limitation for patients with hand dystonia. The efficacy of the intervention is tested with digitized table assessment of handwriting.
|Study Start Date:||July 2008|
|Study Completion Date:||July 2010|
|Primary Completion Date:||July 2010 (Final data collection date for primary outcome measure)|
Repetitive Transcranial Magnetic stimulation: 1 Hz rTMS, 1800 pulses, delivered to premotor cortex during active hand movement. Intervention was delivered every day for 5 days.
Other Name: Magstim Rapid 2, Magstim Co, Whitland Dyfed, UK
This study investigated the short- and long-term effects of repeated administrations of repetitive-transcranial magnetic stimulation (rTMS) on cortical excitability and handwriting performance. Six subjects with focal hand dystonia (FHD) and nine healthy controls were studied. All subjects with FHD received rTMS (1Hz) to the premotor cortex (PMC) for five consecutive days; of those, three subjects received five days of sham rTMS completed ten days prior to real treatment. Healthy subjects received one real rTMS session. Cortical silent period (CSP) and measures of handwriting performance were compared before and after treatment and at ten-day post-treatment follow-up. At baseline, significant differences in CSP and pen pressure were observed between subjects with FHD and healthy controls. Differences in CSP and pen velocity between subjects in real and sham rTMS groups were observed across treatment sessions and maintained at follow-up. After five days of rTMS to PMC, reduced cortical excitability and improved handwriting performance were observed and maintained at least ten days following treatment in subjects with FHD. These preliminary results support further investigation of the therapeutic potential of rTMS in FHD. We have modified the current treatment parameters to increase the treatment time to build upon these initial findings
|United States, Minnesota|
|Program in Physical Therapy, University of Minnesota|
|Minneapolis, Minnesota, United States, 55455|
|Principal Investigator:||Teresa J Kimberley, PhD, PT||University of Minnesota - Clinical and Translational Science Institute|