Coil Positioning in Navigated Transcranial Magnetic Stimulation Feasibility in Depression Patients Trial
Condition: Depressive Disorder, Major
MeSH terms: Depressive Disorder; Depression; Depressive Disorder, Major
Study type: Interventional

Summary: 
      The objective of this study is to evaluate the feasibility of adding a navigational system to
      traditional repetitive Transcranial Magnetic Stimulation (rTMS, referred to in this
      application as nTMS) as a way to establish and maintain precise coil positioning (contact,
      rotation, and tilt) and consistent brain region targeting throughout a nTMS treatment session
      and in subsequent nTMS sessions.
    

Detailed description: 
      Objective: The objective of this study is to evaluate the feasibility of adding a
      navigational system to traditional repetitive Transcranial Magnetic Stimulation (rTMS,
      referred to in this application as nTMS) as a way to establish and maintain precise coil
      positioning (contact, rotation, and tilt) and consistent brain region targeting throughout a
      nTMS treatment session and in subsequent nTMS sessions. Success will be evaluated via data
      analysis of information captured during nTMS, which will evaluate coordinates, contact,
      rotation, and tilt parameters of the stimulation pulses delivered. The study will be
      conducted with patients who have been selected as traditional rTMS candidates and have met
      the criteria for rTMS, which includes, but is not limited to the following: Adults with Major
      Depressive Disorder (MDD) who have failed to achieve satisfactory improvement from prior
      antidepressant medication in the current episode. For the purposes of this study, nTMS is
      referring to the use of a navigation device in combination with delivery of traditional rTMS.

      Aim 1: Determine the percentage of successful nTMS treatment sessions. A successful nTMS
      treatment session is defined as the following: 80% of the TMS pulse trains are delivered
      while the coil is within acceptance criteria measured by tracking the following parameters:
      coil deviations from digitally saved target location, which includes contact (mm), rotation
      (°), and tilt (°) parameters. The acceptance criteria are met with coil position at the time
      of pulse delivery as follows: coil rotation within ±15° of target; coil tilt within ±15° of
      target; in-plane deviation within ±5mm of target; contact deviation within ±2mm of target.

      Aim 2: Determine Patient Health Questionnaire (PHQ-9) change measured weekly from baseline to
      after 30 sessions of nTMS, collect Patient comfort data, measure Operator confidence and
      collect coil position data for nTMS sessions to determine future product improvements and
      clinical studies.

      The goal of this proposal is to establish nTMS as a means of precise administration of
      transcranial magnetic stimulation. Ultimately, data from this study will be used to design
      larger, comparative studies to establish superior efficacy profiles in the treatment of MDD.
    

Intervention name(s): Navigated Transcranial Magnetic Stimulation
Intervention type(s): Device
Intervention description(s): This study is a feasibility trial. Each participant will receive 30sessions of 10 Hz or 20 Hz rTMS over the left DLPFC. The rTMS interventions will be guided by a neuronavigation system (StimGuide TMS Navigation System, Magstim, Ltd. Carmarthenshire, UK) for navigation to the treatment location and to ensure consistent placement and orientation of the coil during and between each session. For the purpose of this protocol, these sessions are referred to as nTMS.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Transcranial Magnetic Stimulation; Navigated Transcranial Magnetic Stimulation