Evaluation of the Effect of Repetitive Transcranial Magnetic Stimulation in Pain Perception in Parkinson's Disease (rTMS)

Study Description

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Brief Summary:

Pain is a frequent symptom in Parkinson's disease. Previous studies have shown that pain perception was altered in Parkinson's disease patients and could be related to nociceptive cortical area hyperactivation. Repetitive Transcranial Magnetic Stimulation is an electrophysiological tool which can modify cortical excitability. Its efficacy was demonstrated in neuropathic pain. This is a randomized, double blind cross-over study. In this study, subjective pain threshold (using thermal stimulation (Thermotest)).will be evaluated in 3 groups of subjects: healthy volunteers, painful Parkinson's patients and pain free Parkinson's disease patients. Each group will receive a high frequency Repetitive Transcranial Magnetic Stimulation and placebo stimulation in different order with a gap of one week.

The investigators supposed that a 20 Hz Repetitive Transcranial Magnetic Stimulation session with an infraliminary intensity on the primary cortical motor, modulating nociceptive cortical areas activity, could modify the nociceptive threshold perception in Parkinson's patients.

Condition or disease	Intervention/treatment	Phase
Parkinson's Disease	Device: Repetitive Transcranial Magnetic Stimulation	Phase 2

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	30 participants
Allocation:	Randomized
Intervention Model:	Crossover Assignment
Masking:	Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:	Basic Science
Official Title:	High Frequency rTMS (Repetitive Transcranial Magnetic Stimulation) Effect Applied on Primary Cortical Motor, on Nociceptive Perception Thresholds in Parkinson's Disease Patients: a Physiopathology Study
Study Start Date :	October 2010
Actual Primary Completion Date :	June 2012
Actual Study Completion Date :	June 2012

Arms and Interventions

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Arm	Intervention/treatment
healthy volunteers; All the patients and healthy volunteers will receive high frequency Repetitive Transcranial Magnetic Stimulation and placebo stimulation	Device: Repetitive Transcranial Magnetic Stimulation; Repetitive Transcranial Magnetic Stimulation will be applied on the contralateral primary cortical motor on the painful side for the Parkinson's disease patients and on the left primary cortical motor for the healthy volunteer. The stimulation frequency will be 20 Hz during 26 min with an intensity stimulation equal of 95% of the motor threshold.; Other Name: non applicable
painful Parkinson's disease patients; All the patients and healthy volunteers will receive high frequency Repetitive Transcranial Magnetic Stimulation and placebo stimulation	Device: Repetitive Transcranial Magnetic Stimulation; Repetitive Transcranial Magnetic Stimulation will be applied on the contralateral primary cortical motor on the painful side for the Parkinson's disease patients and on the left primary cortical motor for the healthy volunteer. The stimulation frequency will be 20 Hz during 26 min with an intensity stimulation equal of 95% of the motor threshold.; Other Name: non applicable
painless Parkinson's disease patients; All the patients and healthy volunteers will receive high frequency Repetitive Transcranial Magnetic Stimulation and placebo stimulation	Device: Repetitive Transcranial Magnetic Stimulation; Repetitive Transcranial Magnetic Stimulation will be applied on the contralateral primary cortical motor on the painful side for the Parkinson's disease patients and on the left primary cortical motor for the healthy volunteer. The stimulation frequency will be 20 Hz during 26 min with an intensity stimulation equal of 95% of the motor threshold.; Other Name: non applicable

Outcome Measures

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Primary Outcome Measures :

1. Change of subjective pain threshold determined using thermal stimulation (Thermotest) with the method of levels after rTMS session [ Time Frame: D1 T0, D1 T1h30mn, D7 T0, D7 T1h30mn ]
   Change from baseline after each Repetitive Transcranial Magnetic Stimulation session (active and placebo)

Secondary Outcome Measures :

1. Analgesic effect of Repetitive Transcranial Magnetic Stimulation using Visual Analogue Scale [ Time Frame: D1 T0, D1 T1h30mn, D7 T0, D7 T1h30mn ]
   Change from baseline after each Repetitive Transcranial Magnetic Stimulation session (active and placebo)
2. - Clinical evaluation of the severity of the motor handicap of patients using Unified's Parkinson's Disease Rating Scale (UPDRSIII) [ Time Frame: D1 T0, D1 T1h30mn, D7 T0, D7 T1h30mn ]
   Change from baseline after each Repetitive Transcranial Magnetic Stimulation session (active and placebo)
3. Mood assessment using Visual Analogue Scale [ Time Frame: D1 T0, D1 T1h30mn, D7 T0, D7 T1h30mn ]
   Change from baseline after each Repetitive Transcranial Magnetic Stimulation session (active and placebo)

Eligibility Criteria

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Ages Eligible for Study:	50 Years to 80 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

For patients:

• Patients with clinical diagnosis of Parkinson's disease according to the criteria of the UKPDSBB
• Parkinson's disease patients with a score≤3 on the Hoehn and Year scale
• Patients treated with dopaminergic antiparkinsonian drugs (L-DOPA, dopamine agonists,ICOMT…)
• Patients with or without neuropathic pain induced by Parkinson's disease
• Patients without personal or familial epilepsy episode history
• Patients from 50 to 80 years old (male or female)
• Patients affiliated to a social protection program
• Patient with an informed consent given

For Healthy volunteers

• Subjects from 50 to 80 years old (male or female)
• Subjects without any serious evolutionary pathology or any clinical significant treatment
• Subjects without chronic pain or disease which can induce neuropathic pain
• Subjects without personal or familial epilepsy episode history
• Subjects affiliated to a social protection program
• Subjects with an informed consent given

Exclusion Criteria:

For patients:

• Patients suffering from an other pathology causing chronic pain (rheumatic disease, traumatic or orthopaedic pathologies…)
• Parkinson's disease patients with a score>3 on the Hoehn and Yahr scale
• Patients with important tremors during a OFF conditions
• Patients suffering from a cancer
• Patients with a neuroleptic treatment
• Patients under tutelage, curatella or law protection
• Patients included in an other clinical study
• Patients unable to fulfil scales of the study
• Patients with personal or familial epilepsy episode history
• Contraindication of IRM
• Pregnant women

For Healthy volunteers:

• Subjects with serious evolutionary pathology or any clinical significant treatment
• Subjects with chronic pain or disease which can induce neuropathic pain
• Subjects with personal or familial epilepsy episode history
• Contraindication of IRM
• Pregnant women
• Subjects under tutelage, curatella or law protection
• Subjects included in an other clinical study

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

France
Purpan Hospital
Toulouse, France, 31000

Sponsors and Collaborators

University Hospital, Toulouse

Investigators

Principal Investigator:	Christine Brefel-Courbon, MD	Toulouse Hospital

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	University Hospital, Toulouse
ClinicalTrials.gov Identifier:	NCT01275573 History of Changes
Other Study ID Numbers:	09 155 02
First Posted:	January 12, 2011
Last Update Posted:	June 19, 2013
Last Verified:	June 2013

Keywords provided by University Hospital, Toulouse:

Repetitive Transcranial Magnetic Stimulation; pain threshold; Parkinson's disease; Pain threshold in Parkinson's disease

Additional relevant MeSH terms:

Parkinson Disease; Parkinsonian Disorders; Basal Ganglia Diseases; Brain Diseases	Central Nervous System Diseases; Nervous System Diseases; Movement Disorders; Neurodegenerative Diseases