Navigation Repetitive Transcranial Magnetic Stimulation in Stroke Rehabilitation

Study Overview
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Brief Summary
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The aim of research to study therapeutic possibilities of navigation transcranial magnetic stimulation in stroke rehabilitation, finding optimal protocol.

Detailed Description
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Stroke is the main cause of long-term disability among adults. Disability following stroke results in significant impairment of patients quality of life. There was a lot of investigations with using Transcranial Magnetic Stimulation (TMS) as effective additional therapy in stroke rehabilitation. In this researches uses different protocols and patient's categories: high-frequency, low-frequency, etc. Using method of navigation transcranial magnetic stimulation with neuroimaging could help in choosing optimal protocol, assess effectiveness of therapy and forming prognosis.

Official Title
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Randomized Controlled Single-blind Research Navigation Repetitive Transcranial Magnetic Stimulation in Stroke Rehabilitation

Conditions
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Stroke

Intervention / Treatment
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* Procedure: Transcranial magnetic stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: a person with confirmed cerebral blood flow by ischemic from 8 days to 3 years in a pool of carotid arteries; Persons with acute cerebrovascular accidents related to the severity of stroke scale NIHSS (National Institute of Health Stroke Scale) from 5 to 20 points; People with cerebral circulatory assessment on the modified Rankin scale at most 3; the availability of informed consent; healthy volunteers who gave informed consent to participate in the study. Exclusion Criteria: The presence of an implanted pacemaker, intracardiac catheters, electronic pumps; The plight of the patient, requiring the maintenance of vital functions by hardware (mechanical ventilation, continuous application infusomats), including an increase of neurological symptoms after 8 days from the start of CVD, myocardial infarction, venous thrombosis of lower extremities, episodes of pulmonary embolism; The severity of neurological deficit, which does not allow the patient to pass on their own 10 meters (you can use additional support); Pregnancy or possibility of pregnancy in women of childbearing age (before menopause), according to a pregnancy test; The presence of metallic elements or implants in the head region, located closer than 20 cm from the edge of the surface coil magnetic stimulator, with the exception of the mouth (metal brackets, vascular sutures, metal plates that cover the defects of the skull, metallic foreign body in the cranial cavity); Identification of epileptiform activity during the screening of EEG before the study; Epilepsy or seizures in history; Patient refusal to participate in the study; Exclusion criteria were: Identified in the study of the general intolerance of the pulsed magnetic field; The development of inclusion in the study after acute myocardial infarction and acute cerebral circulatory disorders; Setting the pacemaker, intracardiac catheters, or operations on the brain, requiring the abandonment of metallic objects in the cranial cavity; The onset of pregnancy; Enhancement of the patient, requiring the maintenance of vital functions by hardware (mechanical ventilation); The emergence of an epileptic seizure in response to the rhythmic TMS; Patient refusal to continue participation in the study;

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Low-frequency stimulation<br>Stimulation mode: 1 Hz, 100% MT, 20 minutes, unaffected hemisphere | Procedure: Transcranial magnetic stimulation<br>* Transcranial magnetic stimulation is a noninvasive technique for including electrical currents in the cerebral cortex by means of time-varying magnetic fields.<br>* Other names: Transcranial magnetic stimulation, brain stimulation;|
| Experimental: High frequency stimulation<br>Stimulation mode: 10 Hz, 80% MT, 2 seconds - stimulation, 58 seconds - rest. - 8 session; affected hemisphere | Procedure: Transcranial magnetic stimulation<br>* Transcranial magnetic stimulation is a noninvasive technique for including electrical currents in the cerebral cortex by means of time-varying magnetic fields.<br>* Other names: Transcranial magnetic stimulation, brain stimulation;|
| Sham Comparator: Sham stimulation<br>Patients will receive standard treatment (kinesotherapy, physiotherapy) and simulate of transcranial magnetic stimulation. Also patients will not know about simulation (blind group) | Procedure: Transcranial magnetic stimulation<br>* Transcranial magnetic stimulation is a noninvasive technique for including electrical currents in the cerebral cortex by means of time-varying magnetic fields.<br>* Other names: Transcranial magnetic stimulation, brain stimulation;|
| Experimental: Both hemispheric stimulation<br>Stimulation mode: low-frequency to unaffected hemisphere than high-frequency to affected. | Procedure: Transcranial magnetic stimulation<br>* Transcranial magnetic stimulation is a noninvasive technique for including electrical currents in the cerebral cortex by means of time-varying magnetic fields.<br>* Other names: Transcranial magnetic stimulation, brain stimulation;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evidence of clinically definite ischemic stroke (focal neurological deficits persisting for more than 24 hours) confirmed by non-investigational CT or MRI |  | up to 20 days | 
| The emergence of epileptic seizure |  | up to 20 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of the clinical condition of the patient | We plan to use different scales to examine clinical condition of patient: Fugl-Meyer scale, Ashworth scale, Perry scale, test with 10 meters walking, Bartel index, Renkin scale | up to 20 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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navigation transcranial magnetic stimulation, stroke rehabilitation