Paired Associative Stimulation in Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke is the third most common cause of death in the United States after heart disease and
      cancer, and the leading cause of long-term disability. This work will develop an innovative
      brain stimulation method (paired associative stimulation) which might set the stage for a new
      treatment for stroke rehabilitation.
    

Detailed description: 
      Stroke is the third most common cause of death in the United States after heart disease and
      cancer. An innovative recovery treatment is in demand for stroke motor recovery. Paired
      associative stimulation (PAS) is a new technique where one pairs a peripheral stimulation
      with centrally applied transcranial magnetic stimulation (TMS), and produces plasticity, as
      measured by TMS motor-evoked potentials (MEP's). The investigators will also compare
      post-stroke patients to healthy controls on the modulation effect of PAS and motor behavior
      measures.

      Aim1. To investigate whether PAS (PAS25 or PAS10) can modulate motor excitability and
      plasticity;

      Aim2. To investigate whether PAS can modify motor behaviors measures in both post-stroke
      patients and healthy controls;

      Aim3. To investigate whether post-stroke patients show different modulation of PAS on both
      cortical plasticity and motor behavior measure compared to healthy controls.

      For this study the investigators will enroll a total of 10 chronic stroke patients and 10
      neurologically healthy controls matched for age and gender. Participants will have 4 visits.
      The first visit is for screening. They will receive either sham PAS or real PAS25 or real
      PAS10 at each following treatment visit.

      Experimental Methods: Clinical Behavioral Measures: Handgrip; Nine-hole Peg Test; Wolf Motor
      Function Test; Imaging protocol: T1 weighted anatomical image, fluid attenuation inversion
      recovery (FLAIR) and diffusion tensor imaging (DTI); Stimulation locations: Left primary
      motor (M1); right median nerve; PAS methods: TMS stimulation will be delivered at 25 ms or 10
      ms or 100 ms after median nerve stimulation.
    

Intervention name(s): Transcranial magnetic stimulation & median nerve stimulation
Intervention type(s): Device
Intervention description(s): Paired associative stimulation (PAS) is a new technique where one pairs a peripheral stimulation with centrally applied transcranial magnetic stimulation (TMS), and produces plasticity, as measured by TMS MEP's. Currently PAS is performed with median nerve stimulation.
PA25: The interval between median nerve stimulation and TMS was chosen to be 25 ms, which is called PAS25. 240 paired TMS and median nerve stimulation at a frequency of 0.2 Hz over 20 min.
PAS10: 240 paired TMS and median nerve stimulation with interval of 10 min second at a frequency of 0.2 Hz over 20 min.
PAS100: 240 paired TMS and median nerve stimulation with interval of 100 min second at a frequency of 0.2 Hz over 20 min.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Device Feasibility
Keywords: Stroke; PAS; TMS; cortical excitability; plasticity