Modulating Movement Intention Via Cortical Stimulation

Study Overview
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Brief Summary
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The purpose of this protocol is to learn about movement intention and volition. To improve such knowledge, investigators will conduct sub-studies using multiple non-invasive methodologies. These results could provide preliminary data for subsequent studies evaluating local and global efficacy of plasticity-inducing treatments for PMD symptoms.

Detailed Description
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This study will: Explore effects of TMS and tDCS on movement intention. Discern the neural activity underlying modulation of movement intention with neuroimaging recording. Identify brain stimulation's effect in patients with psychogenic tremor and non-epileptic seizures. Technical development of new experimental paradigms and data analysis methods. Data collection for hypotheses development.

Official Title
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Modulating Movement Intention Via Cortical Stimulation in Healthy Subjects and Patients With Psychogenic Movement Disorders and Non-epileptic Seizures

Conditions
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Seizures, Seizure Disorder, Psychogenic Movement Disorder

Intervention / Treatment
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* Device: Sham TMS3 stimulation
* Device: rTMS of left or right angular gyrus (AG) or frontal cortex (FC)
* Device: Anodal tDCS of left or right AG or FC


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: (Healthy Controls) Fluent in English (Patients with PMD or PNES): Diagnosis of PMD/PNES confirmed by a neurologist with expertise in movement disorders. Per the treating neurologist, subject is unlikely to require treatment and/or dosage changes for 3-6 months following screening Exclusion Criteria: Any history of a significant neurological disorder, which may interfere with the interpretation of study data, as determined by the PI Chronic or progressive medical condition Any history of traumatic brain injury or significant head trauma Currently meets criteria for substance abuse or dependence History of any psychotic disorder or other psychiatric condition which may interfere with data interpretation Pregnancy Metal or devices in the head, including neurostimulators or metal foreign bodies Any other implanted metal device, including pacemaker, spinal cord stimulator, VNS. Any other ferromagnetic substance in the body that may increase study risk (including dental prosthetics, etc.). Taking tricyclic antidepressant or antiepileptic medications or CNS active drugs under strong potential hazard list in Rossi et al., 2009 Current diagnosis of any inflammatory or autoimmune disorder within last 6 months PMD and PNES Patients Any history of traumatic brain injury or significant head trauma Diagnosis of organic seizure disorder, including febrile seizures and tonic-clonic seizures; Neurological disorder other than PMD and PNES including stroke, fainting spells or syncope of unknown cause(s); Major or unstable medical illness, especially any current diagnosis of inflammatory or autoimmune disorders within last 6 months Metal or devices in the head, including neurostimulators or metal foreign bodies Taking tricyclic antidepressant medications or CNS active drugs under strong potential hazard list in Rossi et al., 2009; Diagnosis of dementia, or Montreal Cognitive Assessment (MoCA) ≤24; Recurrent visual hallucinations, within the past 6 months; History of significant uncontrollable movements of the head; Any clinically significant abnormality on vital signs

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Healthy Patients<br>All healthy volunteers will complete the healthy volunteer form, MRI safety screening form, and the Montreal Cognitive Assessment (MOCA). | Device: Sham TMS3 stimulation<br>* half of the subjects will receive sham stimulation first<br>Device: rTMS of left or right angular gyrus (AG) or frontal cortex (FC)<br>* Half of the subjects will receive active stimulation first; A subject may receive either TMS or tDCS stimulation, but not both, over the course of the sub-study.<br>* Other names: 45 Minutes;Device: Anodal tDCS of left or right AG or FC<br>* Half of the subjects will receive active stimulation first; A subject may receive either TMS or tDCS stimulation, but not both, over the course of the sub-study.<br>* Other names: 30 Minutes;|
| Active Comparator: PMD/PNES patients<br>PMD and PNES subjects will be referred by the treating | Device: Sham TMS3 stimulation<br>* half of the subjects will receive sham stimulation first<br>Device: rTMS of left or right angular gyrus (AG) or frontal cortex (FC)<br>* Half of the subjects will receive active stimulation first; A subject may receive either TMS or tDCS stimulation, but not both, over the course of the sub-study.<br>* Other names: 45 Minutes;Device: Anodal tDCS of left or right AG or FC<br>* Half of the subjects will receive active stimulation first; A subject may receive either TMS or tDCS stimulation, but not both, over the course of the sub-study.<br>* Other names: 30 Minutes;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in signal intensity measured using of tDCS | as a result of altering cerebral perfusion in response to neurophysiologic stimulation | 30 Minutes | 
| Changes in signal intensity measured during EEG recording | as a result of altering cerebral perfusion in response to neurophysiologic stimulation | 3 Hours | 
| Changes in signal intensity measured during MEG | as a result of altering cerebral perfusion in response to neurophysiologic stimulation | 3 Hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Electroencephalography, Magnetoencephalography, Transcranial Magnetic Stimulation