rTMS Posterior Parietal Cortex Modulation and Upper Limb Movement After Stroke

Study Overview
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Brief Summary
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This study evaluates the effect of a unique session of inhibitory rTMS (cTBS) over the contralesional posterio parietal cortex (PPC) on the spatio-temporal parameters of a pointing movement performed by stroke patients with their paretic upper limb. It will also assess the effects on the resting motor threshold of both hemispheres and on parietopremotor connectivity. To achieve theses aims, the real cTBS stimulation will be randomly counterbalanced with a SHAM stimulation (in a second session) in a crossover design. Assessments will be performed before and after each stimulation session.

Official Title
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Influence of the Modulation of the Posterior Parietal Cortex (rTMS) on a Pointing Movement With the Paretic Upper Limb After Stroke

Conditions
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Stroke, Hemiparesis, Transcranial Magnetic Stimulation, Brain Connectivity

Intervention / Treatment
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* Device: repeated transcranial magnetic stimulation continuous theta-burst stimulation
* Device: SHAM repeated transcranial magnetic stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 18 and 80y Right-handed Right hemispheric stroke confirmed by a 3D imaging technique at the chronic phase (>6months) subject being able to perform a pointing movement of at least 20cm in the anterior space without compensatory movements of the trunk informed consent Social security affiliation Exclusion Criteria: Severe comprehension troubles (language, cognitive or psychiatric disorders) History of neurological disorders in addition to the stroke Locomotor troubles affecting the paretic arm Contraindication to rTMS : epilepsy, intracranial metallic foreign body, cochlear implant, unstable fracture of the skull bones, deafness pregnancy or breastfeeding adult subject to guardianship

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: cTBS stimulation<br>continuous theta-burst TMS stimulation (1200 pulses, 50Hz, separated in two sequences of 600 pulses) | Device: repeated transcranial magnetic stimulation continuous theta-burst stimulation<br>* cTBS<br>|
| Sham Comparator: SHAM stimulation (placebo)<br>SHAM stimulation | Device: SHAM repeated transcranial magnetic stimulation<br>* SHAM stimulation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time of movement during the pointing movement | Time between the initiation of the movement and the reaching of the target | 30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reaction time (time between the go signal and th onset of the movement) | temporal parameters of pointing movements | 30 minutes | 
| Response time (time between the go signal and the reaching of the target) | temporal parameters of pointing movements | 30 minutes | 
| Peak velocity of the hand during the pointing movement | pak velocity in m/s | 30 minutes | 
| smoothness (number of units of movement during the pointing movement), | Spatial parameters of pointing movements | 30 minutes | 
| Linearity (ration between the length of the trajectory of the hand and the linear distance between the initial position of the hand and the target) | Spatial parameters of pointing movements | 30 minutes | 
| Detection of mirror movements with the healthy upper limb | EMG detection | 30 minutes | 
| Primary motor cortex excitability of both motor cortices | Resting motor threshold of lesioned and non-lesioned hemispheres | 30 minutes | 
| Parietomotor connectivity in the contralesional hemisphere | Assessed by a paired-pulse TMS protocol (see Allart et al. 2017 for more details) | 30 minutes | 
| Spatial bias | Line bisection test | 30 minutes |