Repetitive Transcranial Magnetic Stimulation in Cervical Dystonia: Effect of Site and Repetition in a Randomized Pilot Trial
Identifieur interne : 000553 ( Main/Exploration ); précédent : 000552; suivant : 000554Repetitive Transcranial Magnetic Stimulation in Cervical Dystonia: Effect of Site and Repetition in a Randomized Pilot Trial
Auteurs : Sarah Pirio Richardson [États-Unis] ; Sule Tinaz [États-Unis] ; Robert Chen [Canada]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
Dystonia is characterized by abnormal posturing due to sustained muscle contraction, which leads to pain and significant disability. New therapeutic targets are needed in this disorder. The objective of this randomized, sham-controlled, blinded exploratory study is to identify a specific motor system target for non-invasive neuromodulation and to evaluate this target in terms of safety and tolerability in the cervical dystonia (CD) population. Eight CD subjects were given 15-minute sessions of low-frequency (0.2 Hz) repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (MC), dorsal premotor cortex (dPM), supplementary motor area (SMA), anterior cingulate cortex (ACC) and a sham condition with each session separated by at least two days. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score was rated in a blinded fashion immediately pre- and post-intervention. Secondary outcomes included physiology and tolerability ratings. The mean change in TWSTRS severity score by site was 0.25 ± 1.7 (ACC), -2.9 ± 3.4 (dPM), -3.0 ± 4.8 (MC), -0.5 ± 1.1 (SHAM), and -1.5 ± 3.2 (SMA) with
ClinicalTrials.gov
Url:
DOI: 10.1371/journal.pone.0124937
PubMed: 25923718
PubMed Central: 4414555
Affiliations:
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Mexico</wicri:regionArea><placeName><region type="state">Nouveau-Mexique</region></placeName></affiliation></author><author><name sortKey="Tinaz, Sule" sort="Tinaz, Sule" uniqKey="Tinaz S" first="Sule" last="Tinaz">Sule Tinaz</name><affiliation wicri:level="2"><nlm:aff id="aff002"><addr-line>Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name><affiliation wicri:level="4"><nlm:aff id="aff003"><addr-line>Toronto Western Research Institute, University of Toronto, Toronto, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto Western Research Institute, University of Toronto, Toronto</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Dystonia is characterized by abnormal posturing due to sustained muscle contraction, which leads to pain and significant disability. New therapeutic targets are needed in this disorder. The objective of this randomized, sham-controlled, blinded exploratory study is to identify a specific motor system target for non-invasive neuromodulation and to evaluate this target in terms of safety and tolerability in the cervical dystonia (CD) population. Eight CD subjects were given 15-minute sessions of low-frequency (0.2 Hz) repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (MC), dorsal premotor cortex (dPM), supplementary motor area (SMA), anterior cingulate cortex (ACC) and a sham condition with each session separated by at least two days. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score was rated in a blinded fashion immediately pre- and post-intervention. Secondary outcomes included physiology and tolerability ratings. The mean change in TWSTRS severity score by site was 0.25 ± 1.7 (ACC), -2.9 ± 3.4 (dPM), -3.0 ± 4.8 (MC), -0.5 ± 1.1 (SHAM), and -1.5 ± 3.2 (SMA) with <italic>negative</italic> numbers indicating improvement in symptom control. TWSTRS scores decreased from Session 1 (15.1 ± 5.1) to Session 5 (11.0 ± 7.6). The treatment was tolerable and safe. Physiology data were acquired on 6 of 8 subjects and showed no change over time. These results suggest rTMS can modulate CD symptoms. Both dPM and MC are areas to be targeted in further rTMS studies. The improvement in TWSTRS scores over time with multiple rTMS sessions deserves further evaluation.</p><sec id="sec001"><title>Trial Registration</title><p>ClinicalTrials.gov <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01859247">NCT01859247</ext-link></p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Batla, A" uniqKey="Batla A">A Batla</name></author><author><name sortKey="Stamelou, M" uniqKey="Stamelou M">M Stamelou</name></author><author><name sortKey="Bhatia, Kp" uniqKey="Bhatia K">KP Bhatia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Skogseid, Im" uniqKey="Skogseid I">IM Skogseid</name></author><author><name sortKey="Roislien, J" uniqKey="Roislien J">J Roislien</name></author><author><name sortKey="Claussen, B" uniqKey="Claussen B">B Claussen</name></author><author><name sortKey="Kerty, E" uniqKey="Kerty E">E 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A" uniqKey="Hanschmann A">A Hanschmann</name></author><author><name sortKey="Grafe, S" uniqKey="Grafe S">S Grafe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nijmeijer, Swr" uniqKey="Nijmeijer S">SWR Nijmeijer</name></author><author><name sortKey="Koelman, Jhtm" uniqKey="Koelman J">JHTM Koelman</name></author><author><name sortKey="Kamphius, Dj" uniqKey="Kamphius D">DJ Kamphius</name></author><author><name sortKey="Tijssen, Maj" uniqKey="Tijssen M">MAJ Tijssen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ricci, R" uniqKey="Ricci R">R Ricci</name></author><author><name sortKey="Salatino, A" uniqKey="Salatino A">A Salatino</name></author><author><name sortKey="Siebner, Hr" uniqKey="Siebner H">HR Siebner</name></author><author><name sortKey="Mazzeo, G" uniqKey="Mazzeo G">G Mazzeo</name></author><author><name sortKey="Nobili, M" uniqKey="Nobili M">M Nobili</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ramos, Vf" uniqKey="Ramos V">VF Ramos</name></author><author><name sortKey="Karp, Bi" uniqKey="Karp B">BI Karp</name></author><author><name sortKey="Hallett, M" uniqKey="Hallett M">M Hallett</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li><li>États-Unis</li></country><region><li>Maryland</li><li>Nouveau-Mexique</li><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="États-Unis"><region name="Nouveau-Mexique"><name sortKey="Pirio Richardson, Sarah" sort="Pirio Richardson, Sarah" uniqKey="Pirio Richardson S" first="Sarah" last="Pirio Richardson">Sarah Pirio Richardson</name></region><name sortKey="Tinaz, Sule" sort="Tinaz, Sule" uniqKey="Tinaz S" first="Sule" last="Tinaz">Sule Tinaz</name></country><country name="Canada"><region name="Ontario"><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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