Electrical Polarization of the Brain in Corticobasal Syndrome
Condition: Corticobasal Syndrome
MeSH terms: Corticobasal Degeneration; Syndrome
Study type: Interventional
Phase: Phase 2

Summary: 
      This study will test whether DC electrical polarization of the brain can temporarily improve
      hand function in patients with corticobasal syndrome (CBS). In this degenerative disorder of
      the brain, nerve cells die over time, causing a progressive decline in the patient's ability
      to use their hands. This is always worse on one side. Other symptoms include arm or leg
      stiffness, tremor, gait unsteadiness, and speech difficulty. Some patients also have some
      decline in thinking ability, such as loss of skilled activities, poor problem solving
      abilities poor concentration, problems with language, and forgetfulness,. DC electrical
      polarization of the brain involves placing sponge electrodes on the head and passing a very
      weak current between them. DC polarization can temporarily improve the ability of healthy
      people to make word lists and may improve symptoms in some brain diseases.

      Patients 40 and older with CBS who have participated in NINDS protocol 02-N-0001 ("Testing a
      Model of the Representational Knowledge Stored in the Human Prefrontal Cortex") may be
      eligible for this study. In protocol 02-N-0001, participants provide a medical history,
      undergo a neurological examination, PET scanning and MRI, and complete tests, such as sitting
      in front of a computer monitor and press a key to indicate a decision about what appears on
      the screen (for example, whether a statement is accurate) and answering questions from a test
      examiner.

      For the current protocol, participants have three 2-hour testing sessions at the NIH Clinical
      Center, scheduled at least one day apart. In each session, sponge electrodes are placed on
      the head so that they affect different areas of the brain. Two areas are involved with hand
      movement; the third does not. The electrodes are dampened with water and attached to the
      sides of the patient's head. When the current is turned on, the patient may feel some
      tingling. The current is on for 40 minutes, but can be reduced or stopped early if the
      tingling becomes uncomfortable.

      Before and during each session, the patients' hand function is tested by having them perform
      and imitate some actions, insert pegs into holes on a board, and tap their index finger as
      fast as they can. Part or all of the sessions are videotaped for use in evaluating the
      effects of DC polarization.
    

Detailed description: 
      Objective: In a recent sham-controlled pilot study, we showed that surface anodal direct
      current (DC) polarization can improve verbal fluency in frontotemporal dementia patients.
      Corticobasilar syndrome is a related disorder that presents with disordered limb movement,
      particularly the loss of stored motor programs, (ideational/ideomotor apraxia) and impaired
      hand function. Conventional neurorehabilitation is typically unsuccessful in this disorder.
      We wish to see whether anodal polarization of the inferior parietal cortex (IPC) in CBS
      patients leads to improved movement and whether the improvement is specifically in the
      generation of stored movements (praxis). We will also apply polarization to the primary
      sensorimotor area (SM1), where we expect any effects to be on elemental aspects of movement,
      such as finger tapping speed. Study population: Twenty CBS patients will be enrolled. Design:
      This single blind crossover study will have three arms: anodal DC to IPC, anodal DC to SM1,
      and a control condition: polarization with the electrodes placed on the right and left
      occipital areas. Outcome Measures: The primary outcome measure is a validated test of
      ideational and ideomotor apraxia. Secondary outcomes are measures of hand dexterity and
      coordination.
    

Intervention name(s): Phoresor II
Intervention type(s): Device
Primary purpose: Treatment
Keywords: Dementia Treatment; Hand Function; Clinical Trials; Dementia; Cortical Syndrome; CBS; Apraxia