rTMS Over the Dorsolateral Prefrontal Cortex for the Treatment of Impulse Control Disorders in Parkinson's Disease

West Virginia University20 enrolled

Overview

This study's objective is to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (dlPFC) of patients with Parkinson's Disease (PD) who experience impulse control disorders (ICDs) on impulse control symptoms and cognitive behaviors linked to ICDs: reinforcement learning and delay-discounting. This is a randomized sham-controlled cross-over trial. All patients will undergo a session of active rTMS and a session of sham rTMS, with the order of sessions randomized across participants. Following recruitment and eligibility screening, the eligible participants will undergo two sessions of rTMS (active and sham), immediately followed by neurocognitive tasks and questionnaires, no more than 1-2 weeks apart. Each session will have a duration of approximately 1-1.5 hours.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Impulse Control Disorder Parkinson Disease

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Clinician-confirmed diagnosis of PD * Ability to provide informed consent, written and verbal * Clinician-diagnosed impulse control disorder or impulse control behaviors including punding/hobbyism and dopamine dysregulation syndrome * A Beck Depression Inventory (BDI) (Beck et al., 1961) score of 14 or lower * A Montreal Cognitive Assessment (MoCA) (Nasreddine et al., 2005) score of 20 or higher * On dopamine-replacement therapy Exclusion Criteria: * History of seizures or epilepsy * History of brain lesions (such as multiple sclerosis, tumor) reported * History of vascular issues in the brain, such as stroke * History of a moderate to severe traumatic brain injury * Meeting the criteria for a major psychiatric illness such as schizophrenia or depression (BDI score of 14 or higher). * Having significant cognitive impairment (assessed by MoCA, cutoff score of 20) (Nasreddine, et al., 2005) * Having had TMS done in the recent past (within a year) * Pregnancy assessed in female patients * Intracranial metallic objects (except for dental fillings) * Current use of substances or medications known to significantly reduce seizure threshold.

Outcomes

Primary Outcomes

Change in Delay-Discounting

Change in performance on a task assessing delay-discounting. Delay-discounting assesses the participants' impulsivity by requiring them to make choices between smaller sooner hypothetical money rewards and larger later hypothetical money rewards (e.g. $10 today vs $100 in a year). This is a hypothetical choice, and the participant will not be receiving the chosen rewards. A short preliminary version of the task will be completed at the start of the first session (prior to TMS) to optimize task parameters for each participant. The task will be completed on a laptop computer.

Time frame: Baseline to 1 hour following the intervention

Change in Reinforcement Learning

Change in performance on a task assessing reinforcement learning. The reinforcement learning task assesses how well participants learn from rewards vs. punishments. The task will ask participants to choose from two stimuli that predict reward (gaining points) or punishment (losing points) at different rates, which they will learn in the course of the task based on feedback. At the end of the task, participants will be asked to rate how well each stimulus predicted reward or punishment.

Time frame: Baseline to 1 hour following the intervention

Secondary Outcomes

Change in impulse control disorder symptoms

Change in impulse control disorder symptoms measured using a modified version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS). QUIP-RS is a self-administered assessment of impulsive and compulsive behaviors in patients with PD. The QUIP-RS is a brief 28-item patient-reported or clinician-rated scale that was developed in PD and derived from the QUIP to measure of severity of ICDs. Each item is rated on a 5-point Likert scale assessing the frequency of symptoms with a range of scores from 0 (never) to 4 (very often).

Time frame: Baseline to 1 hour following the intervention

rTMS Over the Dorsolateral Prefrontal Cortex for the Treatment of Impulse Control Disorders in Parkinson's Disease

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts