search
Back to results

Presurgical Motor Mapping With Transcranial Magnetic Stimulation (TMS)

Primary Purpose

Epilepsy

Status
Active
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
The Magstim Rapid2,
Sponsored by
NYU Langone Health
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Epilepsy focused on measuring Transcranial magnet stimulation (nTMS), Brainsight Neuronavigation, Electromyography, EMG

Eligibility Criteria

12 Years - 60 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 12-60 years of age
  • Planned neurosurgery involving implantation subdural electrodes over the precentral gyrus

Exclusion Criteria:

  • Inability to sign informed consent .
  • Hemiparesis worse than 4-/5 on the side contra lateral to the planned implant
  • Inability to get an MRI, or MRI older than 2 years
  • Frequent (>1 per day) motor seizures
  • Prior neurosurgery
  • Metal in the head, including shrapnel
  • Implanted stimulation devices, including DBS (Deep Brain Stimulator), RNS (Responsive Neurostimulator), VNS (Vagus Nerve Stimulator), PPM (Permanent Pacemaker)
  • Pregnancy
  • Use of a medication known to increase the risk of seizures, including certain antipsychotics (clozapine), bronchodilators (aminophylline, theophylline), immunomodulatory agents (cyclosporine), and antibiotics (penicillins, cephalosporins, amphotericin, imipenem)

Sites / Locations

  • New York University Langone Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

nTMS

Arm Description

Patients will receive a single-pulse TMS mapping of the motor area for the following reasons to determine the motor threshold, measure concurrent EMG, and mapping of the upper extremity.

Outcomes

Primary Outcome Measures

The primary outcome measure will be spatial correlation between topographic maps of hand motor representation obtained through nTMS compared to direct, extra-operative cortical stimulation performed as part of routine clinical care

Secondary Outcome Measures

Full Information

First Posted
April 8, 2016
Last Updated
August 26, 2022
Sponsor
NYU Langone Health
search

1. Study Identification

Unique Protocol Identification Number
NCT02741193
Brief Title
Presurgical Motor Mapping With Transcranial Magnetic Stimulation (TMS)
Official Title
Validation of Presurgical Motor Mapping With Transcranial Magnetic Stimulation (TMS) in Patients With Epilepsy
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
September 10, 2016 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
NYU Langone Health

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The aim of the study is to examine the degree of concordance between presurgical neuronavigation guided TMS (nTMS) and direct cortical stimulation (DCS) in identifying hand motor cortex in adults undergoing epilepsy surgery. Navigated transcranial magnet stimulation (nTMS), MagStim RapidStim2 Magnetic stimulation will be delivered to hand primary motor cortex, with positive and negative functional sites determined through surface electromyography (EMG). The study will involve patients ages 12-60 years, with planned neurosurgery involving implantation of intracranial subdural electrodes including over the precentral gyrus. Navigated transcranial magnet stimulation (nTMS), MagStim RapidStim2 Magnetic stimulation will be delivered to hand primary motor cortex, with positive and negative functional sites determined through surface electromyography (EMG). The primary outcome measure will be spatial correlation between topographic maps of hand motor representation obtained through nTMS compared to direct, extra-operative cortical stimulation performed as part of routine clinical care. A secondary outcome measure will be safety and tolerability of TMS in the epilepsy patients.
Detailed Description
This study will be an open-label feasibility study which applies nTMS to subjects with incoming epilepsy surgery and pre-surgical motor mapping. No study-related medication changes are expected -- participants will remain compliant with their regular anticonvulsant regimen throughout each study phase. All patients will have undergone a complete history and neurological exam as part of their routine clinical care at the New York University (NYU) Comprehensive Epilepsy Center. Fourteen (14) patients will undergo epilepsy surgery with expected subdural grid coverage over primary motor cortex. Potential subjects will be identified at the weekly multi-disciplinary epilepsy conference. Subjects must have a recent (<2 years) MRI scan, and registration of the TMS coil to the MRI scan via the Brainsight neuronavigation system will be utilized to guide TMS coil placement (Gugino et al 2001). When a presurgical fMRI (functional magnetic resonance imaging) is available which demonstrates the patient's hand knob, the fMRI will be used with the Brainsight neuronavigation system. Subjects will be recruited and consented during a presurgical clinical visit where the patient's primary epileptologist will introduce members of the research team. nTMS mapping Patients will receive a session of single-pulse TMS mapping of the motor area, at the outpatient TMS clinic at NYU Neurology Ambulatory Care Center, at 240 E 38th St 20th Floor prior their epilepsy surgery according to the following procedures: Determination of the motor threshold by (1) finding the most excitable region in the hand knob which elicits the strongest compound muscle action potential (CMAP) in the APB muscle; (2) finding the motor threshold by determining output stimulation intensity which generates peak to peak CMAP response above 50 mV (Millivolts) in 5/10 stimulation cycles (Rossini et al., 1994). Concurrent EMG will be measured with electrodes placed at APB (abductor policis brevis atrial premature beat), abductor digiti minimi, flexor carpiradialis muscles. Reference electrode will be placed at the ipsilateral elbow above the brachial biceps muscle. Mapping of the upper extremity. After determination of the MT (motor threshold), mapping of the UE(Upper Extremity) will be performed at 110% of the rMT (resting motor threshold). All positive and negative stimulation sites will be recorded and saved. Patients will be closely monitored during TMS stimulation. Each subject will have a complete neurological examined by a neurologist before and immediately after nTMS. Patients will also be provided a side effects questionnaire after TMS mapping. Patients will then be asked to keep a 7 day seizure diary after the nTMS session. After epilepsy surgery patients will receive the standard care for post-operative patients which including close monitoring in ICU overnight. Patients will be transferred to the floor for further clinical evaluation before discharge. Clinical outcome will be evaluated in the post-operative clinic visit within 1 month after discharge. The value of a clinical follow up is to evaluate for any discrepancy between nTMS and DCS, to determine which modality better predicts functional outcome. Any seizure recurrence or neurological deficit will be recorded at the follow-up clinical visit. The trial is designed to detect strength of spatial correlation between topographic maps of hand motor representation obtained through noninvasive nTMS compared to direct, extra-operative cortical stimulation obtained as part of usual clinical evaluation during epilepsy surgery, as measured by (a) average distance between positive motor mapping sites of DCS compared to nTMS and (b) degree of concordance between positive and negative motor mapping sites between DCS and nTMS, to generate positive and negative predictive values, and (c) average distance between positive motor functional sites of fMRI compared to nTMS.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Epilepsy
Keywords
Transcranial magnet stimulation (nTMS), Brainsight Neuronavigation, Electromyography, EMG

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
14 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
nTMS
Arm Type
Experimental
Arm Description
Patients will receive a single-pulse TMS mapping of the motor area for the following reasons to determine the motor threshold, measure concurrent EMG, and mapping of the upper extremity.
Intervention Type
Device
Intervention Name(s)
The Magstim Rapid2,
Intervention Description
Transcranial Magnetic Stimulation, which is a microprocessor-controlled machine which delivers both single and repetitive transcranial magnetic stimulation (TMS). single and repetitive transcranial magnetic stimulation (TMS). TMS will be applied as single pulses to determine motor evoked potentials (MEPs), there will be no modulation of cortical excitability.
Primary Outcome Measure Information:
Title
The primary outcome measure will be spatial correlation between topographic maps of hand motor representation obtained through nTMS compared to direct, extra-operative cortical stimulation performed as part of routine clinical care
Time Frame
30 minutes

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 12-60 years of age Planned neurosurgery involving implantation subdural electrodes over the precentral gyrus Exclusion Criteria: Inability to sign informed consent . Hemiparesis worse than 4-/5 on the side contra lateral to the planned implant Inability to get an MRI, or MRI older than 2 years Frequent (>1 per day) motor seizures Prior neurosurgery Metal in the head, including shrapnel Implanted stimulation devices, including DBS (Deep Brain Stimulator), RNS (Responsive Neurostimulator), VNS (Vagus Nerve Stimulator), PPM (Permanent Pacemaker) Pregnancy Use of a medication known to increase the risk of seizures, including certain antipsychotics (clozapine), bronchodilators (aminophylline, theophylline), immunomodulatory agents (cyclosporine), and antibiotics (penicillins, cephalosporins, amphotericin, imipenem)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anli Liu, MD, MA
Organizational Affiliation
NYU Langone Health
Official's Role
Principal Investigator
Facility Information:
Facility Name
New York University Langone Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Presurgical Motor Mapping With Transcranial Magnetic Stimulation (TMS)

We'll reach out to this number within 24 hrs