Transcranial Magnetic Stimulation in Progressive Supranuclear Palsy

Oregon Health and Science University30 enrolled

Overview

The objective of this proposal is to investigate the effect of non-invasive repetitive cerebellar transcranial magnetic stimulation (rTMS) on motor control in progressive supranuclear (PSP). The central hypothesis is that augmenting cerebellar inhibition via cerebellar rTMS will decrease postural instability in patients with PSP. We will use functional near infrared spectroscopy (fNIRS) to examine changes in motor and premotor cortical activity after cerebellar rTMS.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Palsy Supranuclear Supranuclear Palsy, Progressive

Interventions

Aim 1: To determine the clinical effects of rTMS targeting the cerebellum on postural instability in PSP. The hypothesis to be tested is that TMS augmentation of cerebellar inhibition will improve cerebellum-dependent balance symptoms of PSP for a period of time sufficient to improve rehabilitation outcomes. The investigators will measure a battery of objective posturography metrics and other measures of motor control, including sway and center of pressure changes to backward tilt and forward translation. Aim 2: We will use functional near infrared spectroscopy (fNIRS) to examine changes in motor and premotor cortical activity after cerebellar rTMS. The hypothesis to be tested is that premotor and motor cortical activity will decrease after cerebellar rTMS compared to sham TMS, reflecting improved cerebellar inhibition of the motor cortex after the intervention.

Eligibility

Sex: ALLMin age: 40 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion Criteria: * probable or possible PSP by the revised MDS PSP Criteria (Hoglinger 2017) * age 40-85 at time of screening * ability to understand and cooperate with simple instructions in English * ability to read at 6th grade reading level in English * ability to stand unassisted for at least 30 seconds and to be able walk independently with a walker * ability to refrain from new physical and speech therapy programs for the duration of the study * ability to remain on stable doses of any cholinergic, dopaminergic, serotonergic sedative or NMDA receptor antagonists for the duration of the study * females of child-bearing age must perform a urine pregnancy test and be on reliable birth control during the course of the study Exclusion Criteria: * other significant neurological or vestibular disorders * presence of electrically, magnetically or mechanically activated implants or history of injurious metal exposure in eyes, head, or body

Outcomes

Primary Outcomes

objective posturography

The primary endpoint is center of pressure shifts with tilt and with translation, and body sway in quiet stance.

Time frame: assessed on 4 days during the 8 week study period

Secondary Outcomes

fNIRS

functional near infrared spectroscopy of premotor and motor areas during balance testing

Time frame: assessed on 4 days during the 8 week study period

speech analysis

speech sample assessment conducted by investigator

Time frame: assessed on 4 days during the 8 week study period

Transcranial Magnetic Stimulation in Progressive Supranuclear Palsy

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts